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Effect of rapid diagnosis on management of influenza A infections
1Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. dnoyola@bcm.tmc.edu
Insights
Rapid influenza A diagnosis using enzyme immunoassay (EIA) in children reduces antibiotic use and duration, while increasing antiviral therapy. This impacts patient management in emergency departments and hospitals.
Area of Science:
- Pediatric Infectious Diseases
- Diagnostic Test Impact Studies
- Viral Diagnostics
Background:
- Limited research exists on how rapid viral diagnostic tests influence patient care.
- Influenza A infections pose a significant burden on pediatric populations.
Purpose of the Study:
- To evaluate the effect of rapid influenza A diagnosis on clinical management strategies.
- To assess the impact of enzyme immunoassay (EIA) results on antibiotic and antiviral prescribing in children.
Main Methods:
- Retrospective review of medical records for children with respiratory infections (n=56) treated between 1995-1997.
- Comparison of children with positive influenza A EIA tests in the Emergency Department (ED) against control groups.
- Analysis of admission rates, antibiotic use, and hospitalization duration based on EIA results.
Main Results:
- Children with positive influenza A EIA tests were less likely to receive antibiotics upon ED discharge (20% vs. 53%).
- Hospitalized patients with positive EIA tests had shorter antibiotic durations (3.5 vs. 5.4 days).
- Positive EIA tests significantly increased the likelihood of receiving antiviral therapy (25% vs. 0% and 1.8%).
Conclusions:
- Rapid influenza A detection via EIA positively impacts pediatric patient management.
- EIA testing reduces overall antibiotic consumption and duration of use in pediatric emergency and inpatient settings.
- Enzyme immunoassay for influenza A encourages appropriate antiviral treatment initiation.
Background:
Few studies have examined the impact of rapid viral diagnostic tests on patient management.
Objective:
To assess the effect of rapid diagnosis of influenza A infections on patient management.
Methods:
The medical records of children with respiratory infections who were evaluated at a children's hospital between July 1, 1995, and June 30, 1997, were reviewed. Children (n = 56) evaluated in the Emergency Department (ED) who had a positive influenza A enzyme immunoassay (EIA) were compared with two control groups for the likelihood of admission, antibiotic use and duration of hospitalization and antibiotic administration.
Results:
Patients discharged from the ED with a positive EIA test were less likely to receive antibiotics than those with a negative EIA test (20% vs. 53%; P = 0.04). Patients admitted to the hospital with a positive EIA test were as likely to receive antibiotics as those without a rapid diagnosis, but the duration of antibiotic administration was significantly shorter in the group with a positive EIA test (3.5 vs. 5.4 days; P = 0.03). Patients with a positive EIA test also were more likely to receive antiviral therapy than either control group (25% vs. 0 and 1.8%; P < 0.001).
Conclusions:
The detection of influenza A by EIA has a positive impact on medical management by decreasing antibiotic use in pediatric patients evaluated in an ED, by decreasing the duration of antibiotic use in hospitalized patients and by encouraging antiviral therapy.