Pooled SARS-CoV-2 antigen tests in asymptomatic children and their caregivers: Screening for SARS-CoV-2 in a pediatric emergency department

•Pooled SARS-CoV-2 antigen tests in a pediatric emergency department are feasible.•Pooling swabs from children and their caregivers keeps additional costs low.•They identify contagious individuals, while waiting for the polymerase chain reaction test result.•Simultaneous swabbing for antigen and polymerase chain reaction tests reduces additional strain to the child. Universal admission screening for SARS-CoV-2 in children and their caregivers (CG) is critical to prevent hospital outbreaks. We evaluated pooled SARS-CoV-2 antigen tests (AG) to identify infectious individuals while waiting for polymerase chain reaction (PCR) test results. This single-center study was performed from November 5, 2020 to March 1, 2021. Nasal mid-turbinate and oropharyngeal swabbing for AG and PCR testing was performed in children with 2 individual swabs that were simultaneously inserted. Nasopharyngeal swabs were obtained from their CG. AG swabs were pooled in a single extraction buffer tube and PCR swabs in a single viral medium. Results from an adult population were used for comparison, as no pooled testing was performed. During the study period, 710 asymptomatic children and their CG were admitted. Pooled AG sensitivity and specificity was 75% and 99.4% respectively for detection of infectious individuals. Four false negatives were observed, though 3 out of 4 false negative child-CG pairs were not considered infectious at admission. Unpooled AG testing in an adult population showed a comparable sensitivity and specificity of 50% and 99.7%. AG performed significantly better in samples with lower Ct values in the corresponding PCR (32.3 vs 21, P-value < .001). Pooled SARS-CoV-2 AGs are an effective method to identify potentially contagious individuals prior admission, without adding additional strain to the child.