%0 Journal Article
%T Optimisation of COVID-19 diagnostic pathways in acute hospital admissions to prevent nosocomial transmission.
%A Livingstone R
%A Woodhead A
%A Bhandari M
%A Dias J
%A Smith T
%A Havelock T
%A Stammers M
%A Livingstone R
%A Woodhead A
%A Bhandari M
%A Dias J
%A Smith T
%A Havelock T
%A Stammers M
%J Clin Respir J
%V 16
%N 9
%D Sep 2022
%M 35922372
%F 1.761
%R 10.1111/crj.13530
%X <B>BACKGROUND: </B>In the management of acute hospital admissions during the COVID-19 pandemic, safe patient cohorting depends on robust admission diagnostic strategies. It is essential that screening strategies are sensitive and rapid, to prevent nosocomial transmission of COVID-19 and maintain patient flow.<BR><B>METHODS: </B>We retrospectively identified all COVID-19 positive and suspected cases at our institution screened by reverse transcription polymerase chain reaction (RT-PCR) between 4 April and 28 June 2020. Using RT-PCR positivity within 7 days as our reference standard, we assessed sensitivity and net-benefit of three admission screening strategies: single admission RT-PCR, composite admission RT-PCR and CXR and repeat RT-PCR with 48 h.<BR><B>RESULTS: </B>RT-PCR single-test sensitivity was 91.5% (87.8%-94.4%) versus 97.7% (95.4%-99.1%) (p = 0.025) for RT-PCR/CXR composite testing and 95.1% (92.1%-97.2%) (p = 0.03) for repeated RT-PCR. Net-benefit was 0.83 for single RT-PCR versus 0.89 for RT-PCR/CXR and 0.87 for repeated RT-PCR at 0.02% threshold probability.<BR><B>CONCLUSIONS: </B>The RT-PCR/CXR composite testing strategy was highly sensitive when screening patients at the point of hospital admission. Real-world sensitivity of this approach was comparable to repeat RT-PCR testing within 48 h; however, faster facilitating improved patient flow.