Variability in the diagnostic performance of a bedside rapid diagnostic influenza test over four epidemic seasons in a pediatric emergency department

Avril, Estelle; Lacroix, Sylvie; Vrignaud, Bénédicte; Moreau-Klein, A.; Coste‐Burel, Marianne; Launay, Élise; Guen, C. Gras-Le

doi:10.1016/j.diagmicrobio.2016.03.015

Cited by 9 publications

(2 citation statements)

References 29 publications

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“…This study found that missed diagnosis of influenza is more likely when using RADTs compared with the Liat influenza A/B test, as RADTs were less sensitive and specific compared with the Liat test. These findings are consistent with previously published studies of RADTs, which found the tests are adequately specific, but have a poor sensitivity that can vary depending on the testing population [ 8 – 10 , 12 , 27 , 28 ].…”

Section: Discussionsupporting

confidence: 92%

Comparing the cobas Influenza A/B Nucleic acid test for use on the cobas Liat System (Liat) with rapid antigen tests for clinical management of Japanese patients at the point of care

Mikamo

Koizumi²,

Yamagishi³

et al. 2022

PLoS ONE

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Background Rapid diagnosis of influenza is critical in preventing the spread of infection and ensuring patients quickly receive antiviral medication to reduce the severity and duration of influenza symptoms, whilst controlling the spread of the causative virus. In Japan patients are often administered anti-influenza medication following a positive rapid antigen detection test (RADT) result. However, the sensitivity of RADTs can lead to false negative results. The cobas® Influenza A/B Nucleic acid test for use on the cobas Liat® System (Liat) is a molecular point-of-care method that can provide a more sensitive alternative to RADTs for rapid influenza diagnosis and treatment. Methods In this prospective multicenter study, diagnostic performance of the Liat test was compared with RADTs in patients presenting with influenza-like-illness. Test performance was also assessed by time since symptom onset. Results Of 419 patients enrolled, 413 were evaluable for all designated tests. Most patients had type-A infection, and only one patient had influenza type B. In 413 patients, the sensitivity and specificity (95% CI) of the Liat test were 99.5% (97.2–99.9%) and 99.5% (97.4–99.9%), respectively, and were 79.7% (73.5–84.7%) and 95.4% (91.7–97.5%) for RADTs. For patients tested <12 hours from symptom onset, the Liat test had significantly higher sensitivity than RADTs (p<0.0001). Conclusion Overall, compared with standard of care RADTs, the Liat test was more sensitive and specific in children and adults, particularly in the early stages of infection. Greater sensitivity can enable earlier diagnosis and may better inform appropriate antiviral treatment decisions.

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Section: Discussionsupporting

confidence: 92%

Comparing the cobas Influenza A/B Nucleic acid test for use on the cobas Liat System (Liat) with rapid antigen tests for clinical management of Japanese patients at the point of care

Mikamo

Koizumi²,

Yamagishi³

et al. 2022

PLoS ONE

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“…Early antiviral initiation is crucial for the treatment of influenza, and point-of-care testing helps clinicians make a decision regarding the prescription of antivirals. 15 16 17 18 Our findings support that early antiviral treatment is associated with a better prognosis in hospitalized children with influenza. 19 20 Malosh et al 21 found that, in a meta-analysis of oseltamivir efficacy and safety in children, when the antiviral was given within 24 hours of symptom onset, the duration of illness was significantly reduced by 22.8 hours.…”

Section: Discussionsupporting

confidence: 75%

Delayed Influenza Treatment in Children With False-Negative Rapid Antigen Test: A Retrospective Single-Center Study in Korea 2016–2019

et al. 2022

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Background We aimed to examine the delay in antiviral initiation in rapid antigen test (RAT) false-negative children with influenza virus infection and to explore the clinical outcomes. We additionally conducted a medical cost-benefit analysis. Methods This single-center, retrospective study included children (aged < 10 years) with influenza-like illness (ILI), hospitalized after presenting to the emergency department during three influenza seasons (2016–2019). RAT-false-negativity was defined as RAT-negative and polymerase chain reaction-positive cases. The turnaround time to antiviral treatment (TAT) was from the time when RAT was prescribed to the time when the antiviral was administered. The medical cost analysis by scenarios was also performed. Results A total of 1,430 patients were included, 7.5% were RAT-positive (n = 107) and 2.4% were RAT-false-negative (n = 20). The median TAT of RAT-false-negative patients was 52.8 hours, significantly longer than that of 4 hours in RAT-positive patients (19.2–100.1, P < 0.001). In the multivariable analysis, TAT of ≥ 24 hours was associated with a risk of severe influenza infection and the need for mechanical ventilation (odds ratio [OR], 6.8, P = 0.009 and OR, 16.2, P = 0.033, respectively). The medical cost varied from $11.7–187.3/ILI patient. Conclusion Antiviral initiation was delayed in RAT-false-negative patients. Our findings support the guideline that children with influenza, suspected of having severe or progressive infection, should be treated immediately.

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Influenza: Underestimated in Children Below 2 Years of Age

Wrotek

Czajkowska

Zawłocka

et al. 2018

Advances in Experimental Medicine and Biology

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Children under 2 years of age may receive antiviral therapy when influenza is suspected. Signs of influenza are frequently unclear and testing is indicated. The aim of the study was to assess the usefulness of clinical signs and the rapid influenza diagnostic test (RIDT) in diagnosing influenza and in choosing the appropriate treatment. In the 2015-2016 influenza season, 89 children under 2 years of age (56.7% of 157 children diagnosed with influenza) were hospitalized. There were 74 RIDT and 70 reverse transcription polymerase chain reactions (RT-PCR) performed for the purpose of diagnosis, either test per child. Eighty-three percent of children (74/89) presented with fever, 55.1% (49/89) with cough, and 39.3% (35/89) with both cough and fever. The RIDT was positive in 31.1% (23/74) of cases. The highest percentage of positive RIDT was within the first 24 h of disease, decreasing dramatically thereafter (70% vs.13-17%, respectively). The RIDT shortened the time to diagnosis by 43.8 h/patient (an average €149 gain in treatment costs). The mean delay for RT-PCR-based diagnosis was 33.5 h/patient (an average €114 loss in treatment costs). We conclude that clinical signs have a low diagnostic sensitivity in children under 2 years of age. Likewise, RIDT is of low sensitivity, being diagnostically useful only in the first 24 h. The PCR is recommended for the diagnosis, but that requires a constant access to the method.

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Variability in the diagnostic performance of a bedside rapid diagnostic influenza test over four epidemic seasons in a pediatric emergency department

Cited by 9 publications

References 29 publications

Comparing the cobas Influenza A/B Nucleic acid test for use on the cobas Liat System (Liat) with rapid antigen tests for clinical management of Japanese patients at the point of care

Comparing the cobas Influenza A/B Nucleic acid test for use on the cobas Liat System (Liat) with rapid antigen tests for clinical management of Japanese patients at the point of care

Delayed Influenza Treatment in Children With False-Negative Rapid Antigen Test: A Retrospective Single-Center Study in Korea 2016–2019

Influenza: Underestimated in Children Below 2 Years of Age

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