tetano
Editor, Senior Moderator
Open Forum Infect Dis
. 2020 Oct 9;7(10)
faa406.
doi: 10.1093/ofid/ofaa406. eCollection 2020 Oct.
Clinical Ordering Practices of the SARS-CoV-2 Antibody Test at a Large Academic Medical Center
Joesph R Wiencek[SUP] 1 2 [/SUP], Carter L Head[SUP] 3 [/SUP], Costi D Sifri[SUP] 4 5 [/SUP], Andrew S Parsons[SUP] 6 [/SUP]
Affiliations
Abstract
Background: The novel severe acute respiratory coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) originated in December 2019 and has now infected almost 5 million people in the United States. In the spring of 2020, private laboratories and some hospitals began antibody testing despite limited evidence-based guidance.
Methods: We conducted a retrospective chart review of patients who received SARS-CoV-2 antibody testing from May 14, 2020, to June 15, 2020, at a large academic medical center, 1 of the first in the United States to provide antibody testing capability to individual clinicians in order to identify clinician-described indications for antibody testing compared with current expert-based guidance from the Infectious Diseases Society of America (IDSA) and the Centers for Disease Control and Prevention (CDC).
Results: Of 444 individual antibody test results, the 2 most commonly described testing indications, apart from public health epidemiology studies (n = 223), were for patients with a now resolved COVID-19-compatible illness (n = 105) with no previous molecular testing and for asymptomatic patients believed to have had a past exposure to a person with COVID-19-compatible illness (n = 60). The rate of positive SARS-CoV-2 antibody testing among those indications consistent with current IDSA and CDC guidance was 17% compared with 5% (P < .0001) among those indications inconsistent with such guidance. Testing inconsistent with current expert-based guidance accounted for almost half of testing costs.
Conclusions: Our findings demonstrate a dissociation between clinician-described indications for testing and expert-based guidance and a significantly different rate of positive testing between these 2 groups. Clinical curiosity and patient preference appear to have played a significant role in testing decisions and substantially contributed to testing costs.
Keywords: COVID-19; SARS-CoV-2; antibody; serology; stewardship; utilization.
. 2020 Oct 9;7(10)
faa406.doi: 10.1093/ofid/ofaa406. eCollection 2020 Oct.
Clinical Ordering Practices of the SARS-CoV-2 Antibody Test at a Large Academic Medical Center
Joesph R Wiencek[SUP] 1 2 [/SUP], Carter L Head[SUP] 3 [/SUP], Costi D Sifri[SUP] 4 5 [/SUP], Andrew S Parsons[SUP] 6 [/SUP]
Affiliations
- PMID: 33072813
- PMCID: PMC7553244
- DOI: 10.1093/ofid/ofaa406
Abstract
Background: The novel severe acute respiratory coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) originated in December 2019 and has now infected almost 5 million people in the United States. In the spring of 2020, private laboratories and some hospitals began antibody testing despite limited evidence-based guidance.
Methods: We conducted a retrospective chart review of patients who received SARS-CoV-2 antibody testing from May 14, 2020, to June 15, 2020, at a large academic medical center, 1 of the first in the United States to provide antibody testing capability to individual clinicians in order to identify clinician-described indications for antibody testing compared with current expert-based guidance from the Infectious Diseases Society of America (IDSA) and the Centers for Disease Control and Prevention (CDC).
Results: Of 444 individual antibody test results, the 2 most commonly described testing indications, apart from public health epidemiology studies (n = 223), were for patients with a now resolved COVID-19-compatible illness (n = 105) with no previous molecular testing and for asymptomatic patients believed to have had a past exposure to a person with COVID-19-compatible illness (n = 60). The rate of positive SARS-CoV-2 antibody testing among those indications consistent with current IDSA and CDC guidance was 17% compared with 5% (P < .0001) among those indications inconsistent with such guidance. Testing inconsistent with current expert-based guidance accounted for almost half of testing costs.
Conclusions: Our findings demonstrate a dissociation between clinician-described indications for testing and expert-based guidance and a significantly different rate of positive testing between these 2 groups. Clinical curiosity and patient preference appear to have played a significant role in testing decisions and substantially contributed to testing costs.
Keywords: COVID-19; SARS-CoV-2; antibody; serology; stewardship; utilization.