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. 2021 Aug 4;10(16):3455.
doi: 10.3390/jcm10163455.

Rapid Antigen Test Combined with Chest Computed Tomography to Rule Out COVID-19 in Patients Admitted to the Emergency Department

Sabrina Kepka  1   2 , Mickaël Ohana  3 , François Séverac  4 , Joris Muller  5 , Eric Bayle  1 , Yvon Ruch  6   7 , Elodie Laugel  7   8 , Mathieu Oberlin  1   9 , Morgane Solis  7   8 , Yves Hansmann  6   7 , Pascal Bilbault  1   10 , Samira Fafi Kremer  7   8
Affiliations

Rapid Antigen Test Combined with Chest Computed Tomography to Rule Out COVID-19 in Patients Admitted to the Emergency Department

Sabrina Kepka et al. J Clin Med. .

Abstract

Objective: Correct and timely identification of SARS-CoV-2-positive patients is critical in the emergency department (ED) prior to admission to medical wards. Antigen-detecting rapid diagnostic tests (Ag-RDTs) are a rapid alternative to Reverse-transcriptase polymerase chain reaction (RT-PCR) for the diagnosis of COVID-19 but have lower sensitivity.

Methods: We evaluated the performance in real-life conditions of a strategy combining Ag-RDT and chest computed tomography (CT) to rule out COVID-19 infection in 1015 patients presenting in the ED between 16 November 2020 and 18 January 2021 in order to allow non-COVID-19 patients to be hospitalized in dedicated units directly. The combined strategy performed in the ED for patients with COVID-19 symptoms was assessed and compared with RT-PCR.

Results: Compared with RT-PCR, the negative predictive value was 96.7% for Ag-RDT alone, 98.5% for Ag-RDT/CT combined, and increased to 100% for patients with low viral load.

Conclusion: A strategy combining Ag-RDT and chest CT is effective in ruling out COVID-19 in ED patients with high precision.

Keywords: RT-PCR; SARS-CoV2; antigen-detecting rapid diagnostic test; chest computed tomography; emergency department.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Management of patients with COVID symptoms in Emergency Departments. Ag-RDT: Antigen-detecting rapid diagnostic tests; CT: Computed Tomography; ED: Emergency Department; RT-PCR: Reverse-transcriptase polymerase chain reaction.
Figure 2
Figure 2
Unenhanced chest CT in a 44-year old-woman with dyspnea and fever for the previous 3 days. Bilateral ground-glass opacities are present, with subpleural predominance and associated interstitial septal thickening. Findings were consistent with typical COVID-19 pneumonia, encompassing 25 to 50% of the total lung parenchyma.
Figure 3
Figure 3
Results of combined strategy compared with RT-PCR.
See this image and copyright information in PMC

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