OBJECTIVES: Acute respiratory tract infections (ARTI) can cause serious problems that require urgent care. Emergency departments (EDs) face the challenge of making accurate treatment decisions under time constraints. The absence of comprehensive, rapid and accurate diagnostic tools at the ED can compromise timely and effective patient care, especially in vulnerable patients, possibly leading to antibiotic misuse and unnecessary hospitalizations. High-plex polymerase chain reaction (PCR) point-of-care testing (POCT) offers a promising alternative by providing immediate and comprehensive pathogen detection. Our objective was to explore the impact of a high-plex POCT system on cost, operational, and health-related outcomes in the German ED compared to current testing practices.

METHODS: An early decision-analytic model compared high-plex PCR POCT (BIOFIRE® SPOTFIRE® R/ST 15 panel) in German EDs with lab-based PCR testing (long vs. short turn-around time) or low-plex PCR POCT, focusing on two critical patient groups: children <5 years and high-risk adults. We explored costs associated with the ED visits, potential hospitalizations, and follow-up from a hospital perspective, along with operational and health-related outcomes. Parameter uncertainty was assessed through sensitivity analyses.

RESULTS: Compared to lab-based testing (12h+) or low-plex POCT, high-plex POCT results in net savings for the hospital (€137.38 to €209.13 per patient) and reduces antibiotic misuse (-3.49% to -15.0%) in both patient groups. High-plex POCT outperforms lab-based testing (2-3h) by reducing ED length of stay (-67.5 min per patient), which can impact ED patient flow and operational efficiency.

CONCLUSIONS: This model-based analysis suggests superiority of high-plex POCT over low-plex and lab-based testing alternatives in the German ED setting, underscoring the value of diagnostic speed and comprehensiveness in both patient groups. Real-world data collection is now required to confirm the potential of high-plex POCT, during and beyond the ED. These studies should consider the entire patient pathway to evaluate the value of immediate and comprehensive diagnostic testing.