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Rapid viral testing in the evaluation of the febrile infant and child
1Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York 11030, USA. rmvega@pol.net
Insights
Rapid viral testing for influenza and respiratory syncytial virus in febrile children significantly impacts clinical decisions, reducing antibiotic use and unnecessary tests. However, current evidence is insufficient to alter established clinical practice guidelines for febrile infants and children.
Area of Science:
- Pediatric infectious diseases
- Clinical virology
- Diagnostic testing
Background:
- Febrile infants and children present diagnostic challenges.
- Distinguishing viral from bacterial infections is crucial for appropriate management.
- Rapid viral testing offers potential to guide clinical decision-making.
Purpose of the Study:
- To review recent literature on rapid viral testing in febrile infants and children.
- To evaluate the impact of rapid viral testing on physician decision-making, antibiotic use, and the rate of serious bacterial infections.
- To assess the influence of rapid viral testing on ancillary testing and hospital resource utilization.
Main Methods:
- Literature review of recent studies on rapid viral testing for influenza and respiratory syncytial virus (RSV).
- Analysis of studies evaluating the impact of rapid viral testing on clinical practice and patient outcomes.
- Examination of research on the prevalence of serious bacterial infections in children with viral illnesses.
Main Results:
- Rapid influenza testing reduced ancillary tests, radiographs, antibiotic use, and length of hospital stay, while increasing antiviral use.
- Febrile children with influenza A infections had a lower prevalence of serious bacterial infections.
- Febrile infants with RSV infections showed a significantly lower risk of serious bacterial infection, though urinary tract infection rates remained notable.
Conclusions:
- Rapid viral testing has demonstrated a significant impact on the evaluation and management of febrile infants and children.
- Current evidence is insufficient to warrant changes in existing clinical practice algorithms for young febrile patients.
- Further research is needed to inform future guidelines and management strategies for febrile infants and children.
Purpose Of Review:
This review focuses on rapid viral testing in the febrile infant and child. Recent literature is reviewed regarding physician decision making, antibiotic use, ancillary testing use, and rate of serious bacterial infections concurrent with viral disease.
Recent Findings:
Two recent studies detail the use of rapid testing of influenza. The impact on the use of ancillary testing and antibiotic prescribing practices based on the knowledge provided by rapid viral testing has been evaluated. Physician awareness of a rapid diagnosis of influenza significantly reduced the number of laboratory tests and radiographs ordered and their associated charges, decreased antibiotic use, increased antiviral use, and decreased length of time to discharge. The rate of serious bacterial infections coexisting with influenza illness has also been studied. Researchers concluded that the prevalence of serious bacterial infections is lower in febrile children with influenza A infection. Another two studies evaluated respiratory syncytial virus-positive febrile infants and their risk of serious bacterial infection. Both studies independently noted that febrile infants with respiratory syncytial virus infections are at significantly lower risk of serious bacterial infection than febrile infants without respiratory syncytial virus infection. The rate of urinary tract infections remained significant in febrile respiratory syncytial virus-positive infants, however.
Summary:
Various studies have documented the impact of rapid viral testing in the evaluation and management of febrile infants and children. There is insufficient evidence to change current clinical practice algorithms for young febrile infants and children. Continued research will affect future guidelines and algorithms in the management of febrile infants and children.
