RTI International, Research Triangle, North Carolina.
Paul G. Allen School for Global Health, Washington State University, Pullman, Washington.
Infect Control Hosp Epidemiol. 2023 Jun;44(6):898-907. doi: 10.1017/ice.2022.174. Epub 2022 Sep 1.
Current guidance states that asymptomatic screening for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) prior to admission to an acute-care setting is at the facility's discretion. This study's objective was to estimate the number of undetected cases of SARS-CoV-2 admitted as inpatients under 4 testing approaches and varying assumptions.
Individual-based microsimulation of 104 North Carolina acute-care hospitals.
All simulated inpatient admissions to acute-care hospitals from December 15, 2021, to January 13, 2022 [ie, during the SARS-COV-2 ο (omicron) variant surge].
We simulated (1) only testing symptomatic patients, (2) 1-stage antigen testing with no confirmatory polymerase chain reaction (PCR) test, (3) 1-stage antigen testing with a confirmatory PCR for negative results, and (4) serial antigen screening (ie, repeat antigen test 2 days after a negative result).
Over 1 month, there were 77,980 admissions: 13.7% for COVID-19, 4.3% with but not for COVID-19, and 82.0% for non-COVID-19 indications without current infection. Without asymptomatic screening, 1,089 (credible interval [CI], 946-1,253) total SARS-CoV-2 infections (7.72%) went undetected. With 1-stage antigen screening, 734 (CI, 638-845) asymptomatic infections (67.4%) were detected, with 1,277 false positives. With combined antigen and PCR screening, 1,007 (CI, 875-1,159) asymptomatic infections (92.5%) were detected, with 5,578 false positives. A serial antigen testing policy detected 973 (CI, 845-1,120) asymptomatic infections (89.4%), with 2,529 false positives.
Serial antigen testing identified >85% of asymptomatic infections and resulted in fewer false positives with less cost per identified infection compared to combined antigen plus PCR testing.
目前的指南规定，在进入急症护理机构之前，对严重急性呼吸冠状病毒病毒 2（SARS-CoV-2）进行无症状筛查由医疗机构自行决定。本研究的目的是估计在 4 种不同检测方法和不同假设下，有多少未被发现的 SARS-CoV-2 感染病例作为住院患者入院。
对北卡罗来纳州 104 家急症医院进行基于个体的微观模拟。
2021 年 12 月 15 日至 2022 年 1 月 13 日期间（即 SARS-COV-2 （奥密克戎）变体激增期间）模拟的所有急症医院住院患者入院。
我们模拟了（1）仅对有症状的患者进行检测，（2）1 阶段抗原检测，无确认性聚合酶链反应（PCR）检测，（3）1 阶段抗原检测，阴性结果采用确认性 PCR，（4）连续抗原筛查（即，在阴性结果后 2 天重复抗原检测）。
在 1 个月内，有 77980 例入院：13.7%为 COVID-19，4.3%为 COVID-19 但非 COVID-19，82.0%为非 COVID-19 指征但无当前感染。如果不进行无症状筛查，将有 1089 例（可信区间[CI]，946-1253）总 SARS-CoV-2 感染（7.72%）未被发现。通过 1 阶段抗原筛查，发现 734 例（CI，638-845）无症状感染（67.4%），假阳性为 1277 例。采用联合抗原和 PCR 筛查，发现 1007 例（CI，875-1159）无症状感染（92.5%），假阳性为 5578 例。连续抗原检测策略检测到 973 例（CI，845-1120）无症状感染（89.4%），假阳性为 2529 例。
与联合抗原加 PCR 检测相比，连续抗原检测可发现>85%的无症状感染，并减少假阳性，每检测到 1 例感染的成本更低。
