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J Am Coll Emerg Physicians Open
. 2022 Jan 15;3(1):e12605.
doi: 10.1002/emp2.12605. eCollection 2022 Feb.
Utility of COVID-19 antigen testing in the emergency department
W Frank Peacock 1 , Karina M Soto-Ruiz 2 , Stacey L House 3 , Chad M Cannon 4 , Gary Headden 5 , Brian Tiffany 6 , Sergey Motov 7 , Kian Merchant-Borna 8 , Anna Marie Chang 9 , Claire Pearson 10 , Brian W Patterson 11 , Alan E Jones 12 , Joseph Miller 13 , Joseph Varon 14 , Aveh Bastani 15 , Carol Clark 16 , Zubaid Rafique 1 , Bory Kea 17 , John Eppensteiner 18 , James M Williams 19 , Simon A Mahler 20 , Brian E Driver 21 , Phyllis Hendry 22 , Eugenia Quackenbush 23 , David Robinson 24 , Jon W Schrock 25 , James P D'Etienne 26 , Christopher J Hogan 27 , Anwar Osborne 28 , Ralph Riviello 29 , Stephen Young 30
Affiliations
- PMID: 35072154
- PMCID: PMC8760952
- DOI: 10.1002/emp2.12605
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.
Keywords: Covid‐19; antigen testing; diagnostic devices; emergency department; nasal swab; point of care.