Utility of COVID-19 antigen testing in the emergency department.

Abstract

Background

The BinaxNOW coronavirus disease 2019 (COVID-19) Ag Card test (Abbott Diagnostics Scarborough, Inc.) is a lateral flow immunochromatographic point-of-care test for the qualitative detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid protein antigen. It provides results from nasal swabs in 15 minutes. Our purpose was to determine its sensitivity and specificity for a COVID-19 diagnosis.

Methods

Eligible patients had symptoms of COVID-19 or suspected exposure. After consent, 2 nasal swabs were collected; 1 was tested using the Abbott RealTime SARS-CoV-2 (ie, the gold standard polymerase chain reaction test) and the second run on the BinaxNOW point of care platform by emergency department staff.

Results

From July 20 to October 28, 2020, 767 patients were enrolled, of which 735 had evaluable samples. Their mean (SD) age was 46.8 (16.6) years, and 422 (57.4%) were women. A total of 623 (84.8%) patients had COVID-19 symptoms, most commonly shortness of breath (n = 404; 55.0%), cough (n = 314; 42.7%), and fever (n = 253; 34.4%). Although 460 (62.6%) had symptoms ≤7 days, the mean (SD) time since symptom onset was 8.1 (14.0) days. Positive tests occurred in 173 (23.5%) and 141 (19.2%) with the gold standard versus BinaxNOW test, respectively. Those with symptoms >2 weeks had a positive test rate roughly half of those with earlier presentations. In patients with symptoms ≤7 days, the sensitivity, specificity, and negative and positive predictive values for the BinaxNOW test were 84.6%, 98.5%, 94.9%, and 95.2%, respectively.

Conclusions

The BinaxNOW point-of-care test has good sensitivity and excellent specificity for the detection of COVID-19. We recommend using the BinasNOW for patients with symptoms up to 2 weeks.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1002/emp2.12605

Publication Info

Peacock, W Frank, Karina M Soto-Ruiz, Stacey L House, Chad M Cannon, Gary Headden, Brian Tiffany, Sergey Motov, Kian Merchant-Borna, et al. (2022). Utility of COVID-19 antigen testing in the emergency department. Journal of the American College of Emergency Physicians open, 3(1). p. e12605. 10.1002/emp2.12605 Retrieved from https://hdl.handle.net/10161/31998.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Eppensteiner

John C Eppensteiner

Assistant Professor of Emergency Medicine

John Eppensteiner, MD is an Assistant Professor in the Department of Emergency Medicine. He completed his emergency medicine training here at Duke University during which time he served as chief resident. He also completed the first-of-its-kind integrated research fellowship year which is now an established pathway in the Duke Emergency Medicine Residency Program. His research interests are primarily focused on the immune response to trauma and early inflammatory biomarkers used in predictive modeling after traumatic injury. Dr. Eppensteiner has also served as site PI for several clinical trials enrolling patients in the Emergency Department.


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