Impact of the Rapid Diagnosis of Influenza on Physician Decision-Making and Patient Management in the Pediatric Emergency Department: Results of a Randomized, Prospective, Controlled Trial

Bonner, Aleta; Monroe, Kathy; Talley, Lynya; Klasner, Ann E.; Kimberlin, David W.

doi:10.1542/peds.112.2.363

Cited by 361 publications

(330 citation statements)

References 15 publications

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“…Influenza rapid test results were available to the physicians at the time of the visit with 59% sensitivity and 97% specificity, which was expected given RIDT performance in previous evaluations 12 , 13 . Our findings were consistent with other studies confirming that testing increases the provision of antiviral therapy for influenza‐positive patients 14 , 15 …”

Section: Discussionsupporting

confidence: 89%

Estimating influenza incidence and rates of influenza‐like illness in the outpatient setting

Fowlkes

Dasgupta

Chao

et al. 2012

Influenza Resp Viruses

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Please cite this paper as: Fowlkes et al. (2012) Estimating influenza incidence and rates of influenza‐like illness in the outpatient setting. Influenza and Other Respiratory Viruses DOI: 10.1111/irv.12014. Background: Estimating influenza incidence in outpatient settings is challenging. We used outpatient healthcare practice populations as a proxy to estimate community incidence of influenza‐like illness (ILI) and laboratory‐confirmed influenza‐associated ILI. Methods: From October 2009 to July 2010, 38 outpatient practices in seven jurisdictions conducted surveillance for ILI (fever with cough or sore throat for patients ≥2 years; fever with ≥1 respiratory symptom for patients <2 years). From a sample of patients with ILI, respiratory specimens were tested for influenza. Results: During the week of peak influenza activity (October 24, 2009), 13% of outpatient visits were for ILI and influenza was detected in 72% of specimens. For the 10‐month surveillance period, ILI and influenza‐associated ILI incidence were 20·0 (95% CI: 19·7, 20·4) and 8·7/1000 (95% CI: 8·2, 9·2) persons, respectively. Influenza‐associated ILI incidence was highest among children aged 2–17 years. Observed trends were highly correlated with national ILI and virologic surveillance. Conclusions: This is the first multistate surveillance system demonstrating the feasibility of using outpatient practices to estimate the incidence of medically attended influenza at the community level. Surveillance demonstrated the substantial burden of pandemic influenza in outpatient settings and especially in children aged 2–17 years. Observed trends were consistent with established syndromic and virologic systems.

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Section: Discussionsupporting

confidence: 89%

Estimating influenza incidence and rates of influenza‐like illness in the outpatient setting

Fowlkes

Dasgupta

Chao

et al. 2012

Influenza Resp Viruses

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“…Moreover, rapid identification of influenza cases may contribute to the limitation of unnecessary antibiotic use and prevention of nosocomial transmission of the virus to high risk hospitalized population groups [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Performance of rapid influenza testing in hospitalized children

Stripeli

Sakkou

Papadopoulos

et al. 2010

Eur J Clin Microbiol Infect Dis

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“…In 1987 it was not possible to perform viral testing in any clinically meaningful or timely manner in the ED. [15][16][17][18][19][20][21] As viral testing becomes more rapid, more available and less expensive, it will also become more common. Viral infections can present subtly, with only fever and nonspecific signs, 4,22,23 but effective treatments are available for some conditions (e.g., acyclovir for HSV).…”

Section: Discussionmentioning

confidence: 99%

“…Viral infections can present subtly, with only fever and nonspecific signs, 4,22,23 but effective treatments are available for some conditions (e.g., acyclovir for HSV). 24 There is growing evidence that viral testing influences physician behaviour, 18 hence the role of specific viral tests in the ED management of neonates will need to be better defined.…”

Section: Discussionmentioning

confidence: 99%

Investigation of afebrile neonates with a history of fever

Brown

Shaw

Moynihan

et al. 2004

CJEM

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Objective: Our objective was to describe clinically significant infections in a cohort of afebrile neonates who underwent an emergency department (ED) septic workup because of the history of a measured fever at home. Methods: Retrospective medical record review of all infants ≤28 days of age who presented to our tertiary care pediatric ED between Jan. 1, 1999, and Aug. 22, 2002, underwent lumbar puncture in the ED, had a reported temperature at home of ≥38°C, and an ED triage temperature of <38°C. Laboratory and radiographic results were tabulated. Results: During the study period, 206 neonates underwent lumbar puncture in our ED. Of these, 108 were excluded because their home temperature was not documented, and 71 were excluded because they were still febrile on presentation to the ED. The study group consisted of the remaining 27 subjects, 4 of whom had received acetaminophen prior to ED arrival. Infections were confirmed in 10 (37%) subjects (3 urinary tract infections, 2 aseptic meningitis, 1 enterovirus meningitis, 1 respiratory syncytial virus bronchiolitis, 1 rotavirus enteritis and 2 pneumonias). Conclusions: Clinically important infections are not uncommon among afebrile neonates undergoing ED septic workup because of a measured fever at home. Some diagnostic testing is warranted in this group, although the clinical utility and indications for specific test modalities remain unclear. RÉSUMÉObjectif : Notre objectif était de décrire les infections cliniquement significatives au sein d'une cohorte de nouveau-nés afébriles ayant subi un bilan septique au département d'urgence (DU) en raison d'antécédents de fièvre mesurée à la maison. Méthodes : Une revue rétrospective fut effectuée des dossiers médicaux de tous les nouveau-nés ≤ 28 jours reçus au DU de notre hôpital pédiatrique de soins tertiaires entre le 1 er janvier 1999 et le 22 août 2002 et qui subirent une ponction lombaire au DU, avaient une fièvre de ≥ 38°C à la maison et une température de triage au DU < 38°C. Les résultats des radiographies et de laboratoire furent totalisés. Résultats : Au cours de la période à l'étude, 206 nouveau-nés subirent une ponction lombaire à notre DU. Parmi ceux-ci, 108 furent exclus parce que leur température à la maison n'avait pas été notée et 71 furent exclus parce qu'ils étaient encore fébriles au DU. Le groupe à l'étude se composait de 27 sujets, dont quatre avaient reçu de l'acétaminophène avant leur arrivée au DU. Des in-

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Impact of the Rapid Diagnosis of Influenza on Physician Decision-Making and Patient Management in the Pediatric Emergency Department: Results of a Randomized, Prospective, Controlled Trial

Cited by 361 publications

References 15 publications

Estimating influenza incidence and rates of influenza‐like illness in the outpatient setting

Estimating influenza incidence and rates of influenza‐like illness in the outpatient setting

Performance of rapid influenza testing in hospitalized children

Investigation of afebrile neonates with a history of fever

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