Configuring Multiplex Interpretation Rules for Infectious Disease Test Panels

This article describes how to add multiplex interpretation rules to an Infectious Disease Test Panel in order for the uploaded results in a workflow to be properly interpreted.

Multiplex interpretation rules are needed if two or more Tests in the Test Panel work together to produce a single result.

Infectious Disease Test Panels are made up of a number of Tests. Each of those Tests are interpreted individually based on the Test Configurations set up for that Test. If any of the Tests require interpretation based on the results of another Test in the Test Panel, then multiplex interpretation rules must be applied to the Test Panel.

Note: If the test panel has not yet been created, first create the Test Panel and Tests using the article for Creating a New Test Panel, Adding Tests to a Test Panel and Setting up Test Configurations, noting the Test Panel Type must be Infectious Disease.

Add Test Panel Attribute

1. Navigate to More > Lab > Test Panels, and select the applicable test panel
2. Click the green Add Attribute button under Custom Attributes
3. Two new fields will appear where you can enter the Key and Value
   1. Enter the Key: multiplexResults
   2. Enter the Value: The value will be a JSON-encoded array containing the interpretation rules. The value for your panel will vary depending on the interpretation needed. See the examples and explanations below.

Example 1: Test Panel contains two Adenovirus targets (AdV_1of2 & AdV_2of2), and if either target is positive, the overall Adenovirus result is positive.

[
  {
    "tests": ["AdV_1of2", "AdV_2of2"],
    "display_name": "Adenovirus",
    "type": "organism",
    "pathogen_class": "Viruses",
    "rules": [
      {
        "detected_tests": ["AdV_1of2", "AdV_2of2"],
        "result": "Detected"
      },
      {
        "detected_tests": ["AdV_1of2"],
        "result": "Detected"
      },
      {
        "detected_tests": ["AdV_2of2"],
        "result": "Detected"
      },
      {
        "detected_tests": [],
        "result": "Not Detected"
      }
    ]
  }
]
	

Example 2: Panel contains Influenza A, Influenza B and an internal control (RNAseP). The internal control must be positive for the Influenza result to be valid.

[
  {
    "tests": ["RNAseP", "FluA", "FluB"],
    "display_name": "Influenza",
    "type": "organism",
    "pathogen_class": "Viruses",
    "rules": [
      {
        "detected_tests": ["RNAseP", "FluA", "FluB"],
        "result": "Influenza A&B Detected"
      },
      {
        "detected_tests": ["RNAseP", "FluA"],
        "result": "Influenza A Detected"
      },
      {
        "detected_tests": ["RNAseP", "FluB"],
        "result": "Influenza B Detected"
      },
      {
        "detected_tests": ["FluA", "FluB"],
        "result": "Invalid"
      },
      {
        "detected_tests": ["FluA"],
        "result": "Invalid"
      },
      {
        "detected_tests": ["FluB"],
        "result": "Invalid"
      },
      {
        "detected_tests": ["RNAseP"],
        "result": "Influenza Not Detected"
      }
    ]
  }
]
	

Multiplex Rule Contents

1. “tests”: Array of the Test Codes to be used in this rule
2. “display_name”: The organism name to be displayed on the patient report that will contain the interpreted result
3. “type”: Use “organism” for pathogen genes; use “antibiotic_class” for resistance genes
4. “pathogen_class”: Use if the Tests in the Test Panel are grouped using the Test attribute pathogenClass. If the Test attribute pathogenClass is not being used, then do not include “pathogen_class” in the multiplex rule
5. “rules”: Specifies the final “result” based on the “detected_tests” (see examples as a guide)
   1. “detected_tests”: Array of the Test Codes that, if detected, should have the “result” specified in the next line
   2. “result”: The result that should be displayed on the patient report if the “detected_tests” in the line above are positive/detected.
      1. The “result” can be any value, however, only a result of “Detected” will appear in bold on the patient report and have an orange flag in the QC step of the workflow
      2. The order of the Test Codes does not matter, but the order of the rules matters. That is, the first rule that fits will be applied, so be sure to put the most complex rules (with the most Test Codes) first.

Show/Hide Tests Included in Multiplex Rules

The Tests used in multiplex rules can either be displayed on the patient report along with the interpreted result, or they can be hidden from the patient report so that only the interpreted result is displayed.

1. Navigate to the applicable Project > Settings tab > select applicable requisition template > Reports
2. Click the 3 dots on the far right of the applicable report configuration > choose Edit
3. In the Configuration section, create a new line inside “display_settings”
   1. If the Tests used in the multiplex rule should be displayed along with the interpreted result, enter “display_multiplex_genes”: “true”
   2. If the Tests used in the multiplex rule should NOT be displayed along with the interpreted result, enter “display_multiplex_genes”: “false”