Abstract Background Point-of-care (POC) PCR tests for sexually transmitted infections (STIs) represent a potential paradigm shift for emergency department (ED) management of patients with suspected STIs, given there are now FDA-cleared POC tests that permit definite rapid diagnosis and result-driven care. Methods A quasi-experimental real-world implementation study was conducted in an urban ED, comparing two approaches for female STI testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV): (1) Central Lab Testing (‘Central’) (August–November 2022) with batched nucleic acid amplification testing (CT/NG) and wet prep for TV; (2) POC PCR Testing Integration (‘ED-POC’) (January–April 2023) in an ED POC laboratory for all three STIs. We compared proportions of appropriate treatment and ED length of stay (LOS) between the 2 testing modalities using chi-square test and log-transformed multivariable linear regression, respectively. Results Of 627 patients, 340 received ‘Central’; 287 received’ED-POC’;’ED-POC’ resulted in a significant decrease in LOS by 76 minutes or 9.3% (95%CI: -16.3%, -1.7%, p=0.017). ‘ED-POC’ also significantly lowered overtreatment rates for CT (n=595) and NG (n=607) by 73% (95%CI: 44%, 87%, p0.001) and 63% (95%CI: 28%, 81%, p=0.002), respectively. ‘ED-POC’ testing was associated with 67% lower rate of undertreatment (95%CI: -19%, 91%, p=0.093) for any CT/NG/TV-positive (n=78), but not statistically significant due to relatively small number of undertreated cases (n=7). Discussion Compared to traditional STI testing, POC PCR testing significantly shortened ED LOS, allowed for organism-specific targeted treatment, and reduced over-treatment of CT and NG infections.
Dashler et al. (Wed,) studied this question.