Does location of rapid influenza diagnostic testing influence treatment time and ancillary testing in a paediatric emergency department?

Abstract

Objective Influenza causes a significant burden of disease. Our aim was to assess whether location of rapid influenza diagnostic testing (RIDT) for patients with influenza‐like illness (ILI) has an impact on ED treatment time or ancillary testing. Methods This was a retrospective observational study in a tertiary paediatric ED during 2017 influenza season. All patients with ILI were included. Some had RIDT performed (ED bedside or at the laboratory). Primary outcome measure was the correlation of RIDT location to treatment time compared to patients with ILI with no RIDT. Secondary outcome measures were the correlation of RIDT location to ancillary testing and treatment with antibiotics. Results A total of 1451 patients with ILI were included. Eighty patients for whom RIDT was performed at the laboratory had a shorter treatment time in the ED when compared to the 215 patients for whom RIDT was performed bedside (2.8 and 3.4 h, respectively; P < 0.0001). However, treatment time was not statistically different when sub‐analysed for admitted and discharged patients separately. Overall, patients with ILI and no RIDT had the shortest treatment time in the ED (1.7 h). There was no difference in ancillary testing and treatment with antibiotics between ILI patients for whom RIDT was performed bedside or at the laboratory regardless of admission. Conclusion Location of RIDT may not have a significant impact on treatment time, ancillary testing and treatment with antibiotics. When RIDT was not performed, patients had the shortest treatment time.

Point-of-care testing in a high-income country paediatric emergency department – a qualitative study in Sweden

“…Such social values are also recognised by our participants, illustrating how test results can curb the insecurities of less experienced doctors, strengthen their credibility in dialogue with senior colleagues and care seekers, help them gain clinical expertise, and increase care seeker satisfaction. At the same time, clinically unjustified testing adds to the workload of the personnel and subjects children to procedures deemed invasive enough to be uncomfortable to them [35,36. Also, reports of over-reliance on technology as a cause of de-skilling clinicians are echoed by our findings stating that doctors would need to rely more on their clinical skills in the scenario in which POCTs are not available to them [5,10,26,37].…”

Diagnostic Stewardship—The Impact of Rapid Diagnostic Testing for Paediatric Respiratory Presentations in the Emergency Setting: A Systematic Review

“…Included studies were published between 2002 [ 28 ] and 2021 [ 13 , 25 ]. Eight of eighteen studies were randomised control trials [ 17 , 18 , 19 , 20 , 22 , 23 , 24 , 25 ], three were prospective cohort studies [ 14 , 15 , 26 ], five were retrospective cohort studies [ 8 , 12 , 21 , 27 , 28 ], one was a before and after interventional study [ 16 ], and one was a pragmatic AB single subject study [ 13 ]. The studies were conducted in several different countries, the majority being in the United States [ 8 , 12 , 16 , 18 , 20 , 22 , 24 , 25 , 26 , 27 , 28 ], but also other countries including United Kingdom [ 13 ], Canada [ 17 ], Australia [ 21 ], Belgium [ 14 ], Brazil [ 15 ], Italy [ 19 ] and Turkey [ 23 ].…”

“…All included studies were conducted in the ED of a paediatric hospital or within the paediatric population of a general hospital, however, the number of hospitals varied between studies. Fifteen of eighteen studies reported outcomes from the paediatric population only [ 8 , 12 , 13 , 15 , 16 , 17 , 19 , 20 , 21 , 23 , 24 , 25 , 26 , 27 , 28 ], and three studies extracted paediatric data from a general hospital [ 14 , 18 , 22 ].…”

“…Nine studies assessed rapid diagnostic tests which assess for the presence of viruses. These tests included Alere i, Quickvue Influenza Test, direct immuno-fluorescence assay, Influenza A/B Rapid Test as well as the use of rapid PCR and enzyme-linked immunosorbent assay (ELISA) testing for influenza and respiratory syncytial virus (RSV) [ 14 , 17 , 19 , 20 , 21 , 23 , 24 , 26 , 28 ]. The remaining six studies used the BioFire FilmArray Respiratory Panel 2 (BioRP2).…”

“…The primary outcomes varied across the included studies, ranging from antibiotic prescription rate to length of patient admission. All studies reported changes in antibiotic prescription rate before and after intervention [ 8 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. Antiviral prescription rate, hospital admission rate, length of stay and use of ancillary testing were also reported in most studies [ 8 , 14 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 24 , 25 , 26 , 27 , 28 ].…”