The turn-around-time (TAT) of diagnostic and screening measures such as testing for SARS-CoV-2 can affect a patient’s length of stay (LOS) in the hospital as well as the emergency department (ED). This, in turn, can affect clinical outcomes. Therefore, a reliable and time-efficient SARS-CoV-2 testing strategy is necessary, especially in the ED. In this randomised controlled trial, n = 598 ED patients presenting to one of three university hospital EDs in Berlin, Germany, and needing hospitalisation were randomly assigned to two intervention groups and one control group. Accordingly, different SARS-CoV-2 testing strategies were implemented: rapid antigen and point-of-care (POC) reverse transcription polymerase chain reaction (rtPCR) testing with the Roche cobas® Liat® (LIAT) (group one n = 198), POC rtPCR testing with the LIAT (group two n = 197), and central laboratory rtPCR testing (group three, control group n = 203). The median LOS in the hospital as an inpatient across the groups was 7 days. Patients’ LOS in the ED of more than seven hours did not differ significantly, and furthermore, no significant differences were observed regarding clinical outcomes such as intensive care unit stay or death. The rapid and POC test strategies had a significantly () shorter median TAT (group one 00:48 h, group two 00:21 h) than the regular central laboratory rtPCR test (group three 06:26 h). However, fast SARS-CoV-2 testing strategies did not reduce ED or inpatient LOS significantly in less urgent ED admissions. Testing strategies should be adjusted to the current circumstances including crowding, SARS-CoV-2 incidences, and patient cohort. This trial is registered with DRKS00023117.

中文翻译：

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急诊科不同 SARS-CoV-2 检测策略对住院时间和临床结果的影响：随机对照试验

SARS-CoV-2 检测等诊断和筛查措施的周转时间 (TAT) 可能会影响患者在医院和急诊科 (ED) 的住院时间 (LOS)。这反过来又会影响临床结果。因此，需要可靠且省时的 SARS-CoV-2 检测策略，尤其是在急诊室。在这项随机对照试验中，n  = 598 名在德国柏林三所大学医院急诊室就诊并需要住院治疗的 ED 患者被随机分配到两个干预组和一个对照组。因此，实施了不同的 SARS-CoV-2 检测策略：使用罗氏 cobas® Liat® (LIAT) 进行快速抗原和即时护理 (POC) 逆转录聚合酶链反应 (rtPCR) 检测（第一组n  = 198） 、使用 LIAT 进行的 POC rtPCR 检测（第二组n  = 197）和中心实验室 rtPCR 检测（第三组，对照组n  = 203）。各组住院患者的住院 LOS 中位数为 7 天。患者在急诊室超过 7 小时的 LOS 没有显着差异，此外，在重症监护室住院或死亡等临床结果方面也没有观察到显着差异。快速和 POC 测试策略具有显着的（)中位 TAT（第一组 00:48 小时，第二组 00:21 小时）比常规中心实验室 rtPCR 测试（第三组 06:26 小时）更短。然而，快速 SARS-CoV-2 检测策略并不能显着减少急诊室急诊入院次数或住院时间。应根据当前情况调整检测策略，包括拥挤、SARS-CoV-2 发病率和患者队列。该试验注册号为 DRKS00023117。