In-vitro diagnostic point-of-care tests in paediatric ambulatory care: A systematic review and meta-analysis

Abstract

Introduction Paediatric consultations form a significant proportion of all consultations in ambulatory care. Point-of-care tests (POCTs) may offer a potential solution to improve clinical outcomes for children by reducing diagnostic uncertainty in acute illness, and streamlining management of chronic diseases. However, their clinical impact in paediatric ambulatory care is unknown. We aimed to describe the clinical impact of all in-vitro diagnostic POCTs on patient outcomes and healthcare processes in paediatric ambulatory care. Methods We searched MEDLINE, EMBASE, Pubmed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science from inception to 29 January 2020 without language restrictions. We included studies of children presenting to ambulatory care settings (general practice, hospital outpatient clinics, or emergency departments, walk-in centres, registered drug shops delivering healthcare) where in-vitro diagnostic POCTs were compared to usual care. We included all quantitative clinical outcome data across all conditions or infection syndromes reporting on the impact of POCTs on clinical care and healthcare processes. Where feasible, we calculated risk ratios (RR) with 95% confidence intervals (CI) by performing meta-analysis using random effects models. Results We included 35 studies. Data relating to at least one outcome were available for 89,439 children of whom 45,283 had a POCT across six conditions or infection syndromes: malaria (n = 14); non-specific acute fever 'illness' (n = 7); sore throat (n = 5); acute respiratory tract infections (n = 5); HIV (n = 3); and diabetes (n = 1). Outcomes centred around decision-making such as prescription of medications or hospital referral. Pooled estimates showed that malarial-POCTs (Plasmodium falciparum) better targeted antimalarial treatment by reducing over-treatment by a third compared to usual care (RR 0.67; 95% CI [0.58 to 0.77],

Latvian Primary Care Management of Children with Acute Infections: Antibiotic-Prescribing Habits and Diagnostic Process Prior to Treatment

“…This situation hinders clinical decision-making, as the FP receives the test results after their patient’s visit, possibly leading to overtreatment or extra visits. POCT in ambulatory care has other benefits over laboratory testing: it is easy to use and more child-friendly, as a finger prick-test is less invasive than a venous puncture; it provides timely results, allowing treatment to be appropriately adapted during the patient’s visit and giving the FP more confidence to withhold unnecessary treatment (which, in turn, manages parents’ expectations for antibiotics and improves their satisfaction) [ 3 , 29 , 30 , 31 , 32 ].…”

“…For instance, an approximately 30% reduction in the prescription rate has been reported. However, the data have mostly been derived from adult populations [ 28 ], and the value of testing for the management of children with acute infections remains unconvincing [ 3 ]. Nevertheless, promising results have been seen in studies where the usage of POCT for C-reactive protein levels and training in communications skills [ 9 ], safety-net advice for parents [ 20 ], and FP educational interventions, were combined [ 33 ].…”

“…Antibiotics are the most commonly administered prescription drugs for children [ 1 ], around 90% of which are prescribed in primary care. Studies in European countries have shown that more than 50% of children have received at least one course of antimicrobial therapy before the age of one [ 2 , 3 ]. Of particular concern is the fact that the highest antibiotic prescription rates are in the age group from two to five years old, as we know that in this age group, viral infections dominate [ 4 ], and the use of broad-spectrum antibiotics rather than narrow-spectrum ones is increasing [ 5 ].…”

“…Several factors contribute to the unwarranted and extensive use of antimicrobials in children in primary care: incomplete clinical evaluation of children with a fever; a lack of evidence-based decisions on the part of doctors; diagnostic uncertainty in differentiating viral and bacterial infections, and a fear of missing serious bacterial infections; an extensive phobia of fever amongst parents [ 9 , 10 ]. These factors also lead to unnecessary hospital referrals, needless additional testing, and an increase in the number of potentially avoidable short-stay hospital admissions for children [ 3 ].…”

“…Point-of-care testing (POCT), defined as medical diagnostic testing at or near the site of patient care, is a fast and simple tool that can support clinical decision-making and improve the quality of primary care for children [ 3 ]. For acute illnesses, POCT such as group A streptococcal antigens, C-reactive protein level, urine strips and bacteriological cultures may be useful and may suppress rushed antibiotic prescribing [ 8 ].…”