Impact of Rapid Molecular Respiratory Virus Testing on Real-Time Decision Making in a Pediatric Emergency Department

Abstract

Acute respiratory illnesses (ARIs) are usually viral [influenza, respiratory syncytial virus (RSV)] and account for 25% of emergency department (ED) peak-season visits. Laboratory PCR testing is accurate albeit slow, whereas rapid antigen testing is inaccurate. We determined the impact of bedside PCR (molecular point-of-care test; mPOCT) on pediatric ARI management. This was a prospective cohort study of consecutive pediatric patients with ED-ordered respiratory PCR test, enrolled over 9 weeks during peak flu season. On ordering, ED physicians were interviewed to ascertain real-time plans if given immediate influenza/RSV PCR results for the current patient. Two groups were compared: actual management and management adjusted for mPOCT results. We compared ED length of stay (LOS), tests ordered, and antibiotic/antiviral ordering. One-hundred thirty-six respiratory PCR panels were ordered, 71 by admitting team, 61 for ED management. Of 61 ED-initiated tests, physicians indicated in 39 cases (64%) they would change patient management were bedside viral results available. Physicians would have decreased ED LOS by 33 minutes, ordered fewer tests (18%; P < 0.001) with average patient charge savings of $669, fewer antibiotics among discharged patients (17%; P = 0.043), and increased appropriate antiviral use (13%; P = 0.023). Rapid bedside ARI mPOCT PCR has the potential to decrease ED LOS, reduce diagnostic tests and patient charges, and increase appropriate use of antibiotics and antiviral agents.

Using a novel rapid viral test to improve triage of emergency department patients with acute respiratory illness during flu season

“…Decreasing outlier TAT for laboratory tests decreases ED LOS [42]. Although our current study was not designed to evaluate rapid POC-PCR impact on ED LOS, our prior study suggests ED LOS reduction by 33 min if POC-PCR is performed during post-rooming ED evaluation, with potential for further reduction if POC-PCR is performed at triage [34]. Additional clinical impact includes reduced ancillary diagnostic testing and costs [30,[27][28][29].…”

“…A convenience subset of 38 patients also had a nasopharyngeal sample sent for laboratory-PCR analysis during the course of their ED treatment, ordered by their treating physician outside of this study. The procedures followed by this laboratory are described by Rogan et al (2017) [34]. Briefly, ED nasopharyngeal swabs for viral testing are sent to an off-site facility where they are batchprocessed then analyzed with the Respiratory Virus Panel XT8 (Gen-Mark) for 9 viruses -influenza A and B, RSV, parainfluenza 1-4, metapneumovirus, rhinovirus, adenovirus, and coronavirus; TAT is 8-24 hrs.…”

Epidemiology of viral respiratory infections in children undergoing heart surgery

“…The clinical value of these rapid tests in children with CHD is unknown. In children admitted to an emergency department, bedside testing for RSV, if immediately available, could have changed medical management in 64% of cases, reduced the number of tests ordered, antibiotics prescribed, and saved an average of USD 669 per patient [17]. Another issue that may be considered is the lack of preventive strategies for most of the viruses that cause VRI in these patients, besides RSV.…”

Syndromic panels or the panels' syndrome? A perspective through the lens of respiratory tract infections: author's response

“…In particular, short turnaround times have an impact on clinical management when testing for influenza virus and respiratory syncytial virus (RSV). Among paediatric patients, the use of rapid tests demonstrated a decrease in emergency department length of stay, a reduction in further diagnostic tests, and an increase in the appropriate use of antibiotics and antivirals [5]. Similarly, a more appropriate use of oseltamivir, shorter time to isolation, and a reduction in length of stay were also shown among adults [6].…”