OBJECTIVES: Molecular tests, including polymerase chain reaction (PCR), can detect lower concentrations of viral material over a longer period of respiratory infection than antigen tests. Delays associated with central laboratory testing can result in hospital-acquired transmission, avoidable patient admission, and unnecessary use of antimicrobials may lead to increased cost of patient management. The aim of this study was to summarize comparisons of the clinical and economic outcomes associated with PoC molecular testing versus other diagnostic tests for viral respiratory infections.

METHODS: An SLR conducted in April 2023 identified studies evaluating clinical and economic outcomes of molecular and antigen diagnostic tests for patients suspected of having a respiratory virus infection.

RESULTS: The SLR included 232 studies, of which nine and 17 compared PoC molecular testing to other diagnostic tests for COVID-19 and influenza, respectively. Studies that tested for COVID-19 generally concluded that PoC molecular testing reduced median time to test result (0.18-3.1 hours vs. 4.29-26.4 hours; n=7 studies) and median length of emergency department stay (3.2-7.2 hours vs. 4.6-12.0 hours; n=4 studies) compared to laboratory PCR. PoC molecular testing was also found to decrease exposure time of uninfected patients and frequency of antiviral and antibacterial therapy, while improving patient flow and preventing healthcare-associated and hospital-acquired infections. A similar trend was observed in studies testing for influenza in that PoC molecular testing led to reduced time to test result and length of stay in hospital or emergency department compared to antigen tests or laboratory PCR, while reducing rates of hospitalization or emergency admission.

CONCLUSIONS: Compared to other diagnostic tests, PoC molecular testing improves clinical outcomes, test turnaround time, and stewardship by decreasing unnecessary use of antibiotics and antivirals. It shifts cost away from more expensive settings by reducing length of stay at hospital and avoiding unnecessary exposure of patients to hospital-acquired infections.