A study to assess the impact of cobas Liat point-of-care PCR assays (SARS-CoV-2 and Influenza A/B) on patient clinical management in the emergency department of the University of California at Davis Medical Center

Abstract

AbstractBackgroundRapid detection of SARS-CoV-2 is crucial for reduction of transmission and clinical decision-making. The cobas® SARS-CoV-2 & Influenza A/B nucleic acid test for use on the cobas Liat® System is a rapid (20 minutes) point-of-care (POC) polymerase chain reaction (PCR) method.MethodsThis unblinded, pre-post study enrolled consecutive patients with symptoms/signs consistent with SARS-CoV-2 infection presenting to the University of California, Davis emergency department (ED). Outcomes following implementation of the cobas Liat SARS-CoV-2 & Influenza A/B test (intervention period: December 2020–May 2021) were compared with previous standard-of-care using centralized laboratory PCR methods (control period: April 2020–October 2020).ResultsElectronic health records of 8879 symptomatic patients were analyzed, comprising 4339 and 4540 patient visits and 538 and 638 positive SARS-CoV-2 PCR test results in the control and intervention periods, respectively. Compared with the control period, turnaround time (TAT) was shorter in the intervention period (median 0.98 vs 12.3 hours; p<0.0001). ED length of stay (LOS) was generally longer in the intervention period compared with the control period, but for those SARS-CoV-2-negative who were admitted, ED LOS was shorter (median 12.53 vs 17.93 hours; p<0.0001). Overall, the rate of anti-infective prescribing was also lower in the intervention period than in the control period (antibiotics only: 38.11% vs 44.55%; p<0.0001 and antivirals only: 3.13% vs 0.94%; p<0.0001).ConclusionThis real-world study confirms faster TAT with a POC PCR method in an emergency care setting and highlights the importance of rapid SARS-CoV-2 detection to aid patient management and inform treatment decisions.Clinical RelevanceThis study reports data collected from a quasi-experimental pre-post study using the electronic health records of patients presenting to the emergency department (ED) of the University of California at Davis Medical Center with symptoms or signs consistent with SARS-CoV-2 infection during their ED visit. The primary objective of this study was to determine if implementation of the point-of-care (POC) cobas® Liat® SARS-CoV-2 & Influenza A/B test for use on the cobas Liat System reduced the diagnostic turnaround time and/or length of stay for ED patients with suspected SARS-CoV-2 infection compared with the previous standards of care (batch-wise diagnostic testing using the cobas 6800 System and on-demand urgent testing on the GenMark Dx® ePlex® system in a centralized clinical laboratory). Ultimately, these data help to inform how implementation of POC molecular testing methods impact patient management.