The Influence of Rapid Influenza Diagnostic Testing on Clinician Decision-Making for Patients With Acute Respiratory Infection in Urgent Care

Abstract

Background The potential benefits of utilizing rapid influenza diagnostic tests (RIDT) in urgent care facilities on clinical care and prescribing practices are understudied. We compared antiviral and antibiotic prescribing, imaging, and laboratory ordering in clinical encounters with and without RIDT results. Methods Our study compared patients with acute respiratory infection (ARI) symptoms who received an RIDT and patients who did not at two urgent care facilities. Primary analysis using one-to-one exact matching resulted in 1145 matched pairs to which McNemar’s 2x2 tests were used to assess association between the likelihood of prescribing, imaging or laboratory ordering, and RIDT use. Secondary analysis compared the same outcomes using logistic regression among the RIDT-tested population between participants who tested negative (RIDT(-)) and positive (RIDT(+)). Results Primary analysis identified that compared to patients without RIDT testing, RIDT(+) patients were more likely to be prescribed antivirals (OR:10.23; 95% CI:5.78-19.72) and less likely to be prescribed antibiotics (OR:0.15; 95% CI:0.08-0.27). Comparing all RIDT-tested participants to all non-RIDT-tested participants, RIDT use increased antiviral prescribing odds (OR:3.07; 95% CI:2.25-4.26) and reduced antibiotic prescribing odds (OR:0.52; 95% CI:0.43-0.63). The secondary analysis identified an increased odds of prescribing antivirals (OR:28.21; 95% CI:18.15-43.86; P <0.0001) and a decreased odds of prescribing antibiotics (OR:0.20; 95% CI:0.13-0.30; P <0.0001) for RIDT(+) participants compared to RIDT(-). Conclusions Utilization of RIDTs in patients presenting to urgent care with ARI symptoms influences clinician diagnostic and treatment decision-making, which could lead to improved patient outcomes, population-level reductions in influenza burden, and a decreased threat of antibiotic resistance.

A Wash-Free Spheres-on-Sphere Strategy for On-Site and Multiplexed Biosensing

“…The equation for the velocity of a sphere as it sinks in solution as a function of time is obtained by adding the inertial force to the other forces in Stokes' law (4): The initial condition is set to be v(0) = 0, which can be obtained as follows (6):…”

“…4,5 These pandemics highlight the unmet diagnostic need to accurately identify and screen patients with respiratory viral infections to facilitate precise management and treatment. 6,7 Since these respiratory viruses cause similar symptoms such as colds, wheezing, asthma, recurrent respiratory infections, and even fatal pneumonia, it is challenging to determine the appropriate treatment for individual patients. 8,9 Additionally, co-infection with multiple respiratory viruses increases the infectivity that exacerbates patient conditions.…”

“…Respiratory diseases caused by severe acute respiratory viruses (e.g., SARS-CoV-2, influenza virus, and parainfluenza virus) have significantly threatened global health. − These viruses are highly infectious, are variable, and can spread quickly among populations and have triggered several global pandemics that resulted in millions of deaths and disabilities. , These pandemics highlight the unmet diagnostic need to accurately identify and screen patients with respiratory viral infections to facilitate precise management and treatment. , Since these respiratory viruses cause similar symptoms such as colds, wheezing, asthma, recurrent respiratory infections, and even fatal pneumonia, it is challenging to determine the appropriate treatment for individual patients. , Additionally, co-infection with multiple respiratory viruses increases the infectivity that exacerbates patient conditions. − In addition, the effects of mycotoxins on the immune system have attracted more attention. The damages to the immune system caused by mycotoxins (e.g., aflatoxin B1, deoxynivalenol, and ochratoxin A) mainly consist of injury to immune organs, programmed cell death of immune cells, and alterations in the secretion of immune factors, which greatly increase the risk of infection with respiratory viruses. , Therefore, the early and simultaneous detection of respiratory viruses and mycotoxins is essential for rapidly guiding clinical treatment for patients.…”

Plasmonic Fluorescence Sensors in Diagnosis of Infectious Diseases

“…While evidence of ‘antigenic sin’ in humans exists, there is still a growing need for further research to comprehensively grasp the mechanisms behind the initiation of human antibody responses and the impact of these antibodies on viral evolution and vaccine efficacy [ 57 , 58 , 59 ]. Various diagnostic methods are employed to detect influenza virus infections in humans, encompassing viral isolation in cell culture [ 60 ], immunofluorescence assays [ 61 , 62 , 63 ], serological assays [ 64 , 65 ], immunochromatography-based rapid diagnostic tests [ 66 , 67 , 68 , 69 ], nucleic acid amplification tests [ 70 , 71 , 72 ] and microchip devices [ 73 , 74 , 75 , 76 , 77 ], among other techniques. Multiple platforms are utilized in the production of influenza virus vaccines, encompassing whole-virus inactivated vaccines, split vaccines, subunit vaccines, live attenuated influenza vaccines (LAIVs), recombinant influenza virus vaccines, cell-culture-derived seasonal influenza virus vaccines, and virus-like particles (VLPs) [ 78 , 79 , 80 , 81 , 82 ].…”

The role of viral diagnostic tests in respiratory tract infections: moving forward

“…After the COVID pandemic this helped to raise the awareness on the potential benefits of an accurate management of viral infections [ 2 ]. This followed NICE’s guideline for the treatment and prevention of neonatal infections, guidelines on the usage of diagnostic tests in emergency care [ 3 ] or an evaluation by NIHR on the benefits of early testing and rapid isolation [ 4 ]. The increased knowledge on virology and the increased potential of virus diagnostic has risen a series of relevant question on the role of an early diagnostic and potential early treatment on the management of respiratory tract infections (RTI).…”