Negative predictive value of the FebriDx host response point-of-care test in patients presenting to a single Australian emergency department with suspected COVID-19: an observational diagnostic accuracy study

Paul Buntine; Joseph Miller; Alun Pope; Stephen Guy; Fang Qi (Alex) Wong; Hannah McDonald; Mania Ahmed; Kang Hui Teow; Morgan Roney; Farzaneh Mohammadi; Emogene Aldridge; Liam Hackett; Susanna Jenner; Belinda Davis

doi:10.1136/bmjopen-2022-065568

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Negative predictive value of the FebriDx host response point-of-care test in patients presenting to a single Australian emergency department with suspected COVID-19: an observational diagnostic accuracy study

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Comparing the Febridx device in accident and emergency and general practice
Ian Charlton, Jodie Marquez, Mark Hollands, Michael Fenton, Winston Latter and Gillian Charlton
Published on: 18 January 2023

Published on: 18 January 2023
Comparing the Febridx device in accident and emergency and general practice
- Ian Charlton, General Practitioner Kincumber Doctors and University of Newcastle
- Other Contributors:
  Jodie Marquez, Senior Lecturer
  
  Mark Hollands, General Practitioner
  
  Michael Fenton, General Practitoner
  
  Winston Latter, General Practitioner
  
  Gillian Charlton, Practice Nurse
It was interesting to read Buntine et al’s (1) experience with the Febridx Point of Care Device in the Accident and Emergency setting. They found a negative predictive value of 80% and a positive predictive value of 78%. The results from our study in general practice demonstrated a negative predictive value of 43%.

We commenced the use of the Febridx device in an Australian general practice in November 2020, just prior to the outbreak of Covid 19. Our study used clinical follow up, rather than biological markers to determine Febridx effectiveness.

Our study was designed to compare antibiotic prescribing in those doctors using the device to determine the difference between viral and bacterial illness compared to those doctors relying on their usual clinical skills. Our study was sabotaged by the advent of Covid 19 and the introduction of lockdowns, isolation, and telehealth. Like much of the country, we saw presentations for URTI’s and the subsequent use of all antibiotics, especially those associated with respiratory disease, decrease.

Our six-doctor general practice used Best Practice clinical software to determine the number of antibiotics prescribed and the number of patients seen each month for each doctor.

In the 6 months prior to covid epidemic, prescribing of respiratory antibiotics (Amoxycillin, Amoxycillin/Clavulanic acid, Cephalexin, Roxithromycin, Trimethoprim/sulfamethoxazole, Clindamycin, Ciproxin, penicillin) was 7.3 antibiotics...
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It was interesting to read Buntine et al’s (1) experience with the Febridx Point of Care Device in the Accident and Emergency setting. They found a negative predictive value of 80% and a positive predictive value of 78%. The results from our study in general practice demonstrated a negative predictive value of 43%.

We commenced the use of the Febridx device in an Australian general practice in November 2020, just prior to the outbreak of Covid 19. Our study used clinical follow up, rather than biological markers to determine Febridx effectiveness.

Our study was designed to compare antibiotic prescribing in those doctors using the device to determine the difference between viral and bacterial illness compared to those doctors relying on their usual clinical skills. Our study was sabotaged by the advent of Covid 19 and the introduction of lockdowns, isolation, and telehealth. Like much of the country, we saw presentations for URTI’s and the subsequent use of all antibiotics, especially those associated with respiratory disease, decrease.

Our six-doctor general practice used Best Practice clinical software to determine the number of antibiotics prescribed and the number of patients seen each month for each doctor.

In the 6 months prior to covid epidemic, prescribing of respiratory antibiotics (Amoxycillin, Amoxycillin/Clavulanic acid, Cephalexin, Roxithromycin, Trimethoprim/sulfamethoxazole, Clindamycin, Ciproxin, penicillin) was 7.3 antibiotics prescriptions per 100 patient encounters. During the pandemic it fell to 4.4 prescriptions per 100 encounters. In the last 6 months it has risen to 7.2.

Prior to Covid taking over the community in February 2020 we were able to enrol 32 patients into our study and follow their progress. Thirty patients tested negative (one band). Two patients tested positive for bacterial infection with two bands and were treated with antibiotics. No patients tested positive for three bands ie viral infection. Subsequent follow up of all patients, a week later, resulted in 17(57%) of those in the negative Febridx test group requiring antibiotics for unresolved symptoms. Some of these patients had then been unwell for 6 weeks prior to their course of antibiotics.

This has led us to question the role of point of care testing in the general practice setting. Our practice has served our suburban community for 40 years. The patients have learnt to treat most URTI as viral and only present after prolonged symptoms. We suspect that this may have meant that first presentation was beyond the window of the Febridx’s usefulness which is now regarded as the first week of the illness and ideally associated with a fever (2). By introducing the Febridx late into the illness process we delayed the use of antibiotics and the patient’s recovery in over half (17/32) those in the study.

The study has been a useful audit of our practice antibiotic prescribing and highlighting the number of patients requiring antibiotics to get better. Whilst Febridx has demonstrated a usefulness in the accident and emergency setting it may be that time is still the most powerful diagnostic tool in general practice.

This study was supported by Lumos diagnostics who provided the Febridx devices for no cost. The Study was overseen by the University of Newcastle ethics committee.

References

1. Paul Buntine 1 2, Joseph Miller 3 2, Alun Pope 2 4, Stephen Guy 2 5, Fang Qi Alex Wong 6 7, Hannah McDonald 6 8, Mania Ahmed 2 9, Kang Hui Teow 2 10, Morgan Roney 1 2, Farzaneh Mohammadi 1 11, Emogene Aldridge 1 2, Liam Hackett 1 2, Susanna Jenner 1, Belinda Davis 1 Negative predictive value of the FebriDx host response point-of-care test in patients presenting to a single Australian emergency department with suspected COVID-19: an observational diagnostic accuracy study BMJ Open. 2022 Dec 29;12(12)

2. Shapiro NI, Self WH, Rosen J, Sharp SC, Filbin MR, Hou PC, et al. A prospective, multi-centre US clinical trial to determine accuracy of FebriDx point-of-care testing for acute upper respiratory infections with and without a confirmed fever. Ann Med. 2018;50(5):420-9.
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Conflict of Interest:
None declared.
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