The Use of Rapid COVID-19 Antigen Test in the Emergency Department as a Decision-Support Tool

Abstract

The emergency department (ED) is the initial point of contact between hospital staff and patients potentially infected with SARS-CoV-2, thus, prevention of inadvertent exposure to other patients is a top priority. We aimed to assess whether the introduction of antigen-detecting rapid diagnostic tests (Ag-RDTs) to the ED affected the likelihood of unwanted SARS-CoV-2 exposures. In this retrospective single-center study, we compared the rate of unwarranted exposure of uninfected adult ED patients to SARS-CoV-2 during two separate research periods; one before Ag-RDTs were introduced, and one with Ag-RDT used as a decision-support tool. The introduction of Ag-RDTs to the ED significantly decreased the relative risk of SARS-CoV-2-negative patients being incorrectly assigned to the COVID-19 designated site ("red ED"), by 97%. There was no increase in the risk of SARS-CoV-2-positive patients incorrectly assigned to the COVID-19-free site ("green ED"). In addition, duration of ED admission was reduced in both the red and the green ED. Therefore, implementing the Ag-RDT-based triage protocol proved beneficial in preventing potential COVID-19 nosocomial transmission.

Keywords: COVID-19; SARS-CoV-19; antigen; decision-making; emergency department; rapid tests; triage; triage protocol.

Figure 1

Daily detected SARS-CoV-2 cases in Israel and Sheba Medical Center during the study periods. The black arrows indicate study periods 1 (21 August 2020–4 October 2020) and 2 (7 December 2020–21 March 2021).

Figure 2

(a) The triage protocol during period 1, prior to the introduction of Ag-RDTs to the ED. (b) The triage protocol during period 2, while Ag-RDT was used as a decision-support tool.