Mapping the Literature on the Impact of Gastrointestinal Multiplexed Pathogen Panels on Clinical and Healthcare Utilization Outcomes: A Scoping Review

TL;DR

This scoping review maps existing research on how gastrointestinal pathogen panels affect clinical outcomes and healthcare use, finding a lack of studies on long-term impacts.

Contribution

The study systematically maps literature on GPPs' impact across healthcare settings, highlighting gaps in proximal and distal outcome research.

Findings

Most studies focused on diagnostic accuracy and organism detection, with fewer on time to diagnosis or antibiotic changes.

Few studies reported on proximal and distal outcomes, indicating a need for more research on long-term impacts.

Common GPPs studied were LDTs and the Biofire® FilmArray® Gastrointestinal Panel.

Abstract

Gastrointestinal pathogen multiplex panels (GPPs) can test a single stool specimen for multiple pathogen targets in less than 5 h with some as little as 1 h. Although GPPs have demonstrated rapid and sensitive detection, their increased cost and unclear reimbursement structures have put into question their value and role in the cost-effective management of patients with gastrointestinal infections. We performed a scoping review to identify and systematically map the existing literature regarding the impact of GPPs on immediate, proximal, and distal clinical and healthcare utilization outcomes across healthcare settings.

Databases were searched from inception until November 22, 2022. Full research articles in English were eligible for inclusion if they included a multiplexed (≥3 targets) nucleic acid amplification testing method and conventional microbiology comparator method performed on clinical samples.

A total of 6027 potential studies were identified. Following title and abstract screening and full article review, 175 studies were included. The most frequently studied GPPs were laboratory-developed tests (LDTs) (34.9%) and the Biofire® FilmArray® Gastrointestinal Panel (22.3%). The majority of these studies were conducted in the inpatient (37.1%), outpatient (28.0%), and emergency department (ED) (14.0%) settings. The most frequently reported outcomes included diagnostic accuracy (69.7%), organism detection (59%), time to diagnosis (12.6%), and antibiotic changes (8.6%).

We identified a paucity of research reporting on proximal and distal outcomes associated with GPP use. Our review highlights the critical need for well-designed studies focusing on downstream clinical and healthcare utilization outcomes to guide meaningful and cost-effective incorporation of GPPs into diagnostic work flows.

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