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Rapid Molecular Detection and Differentiation of Influenza Viruses A and B
Published on: January 30, 2017
Impact of Rapid Influenza Molecular Testing on Management in Pediatric Acute Care Settings
Rana E El Feghaly1, John David Nolen2, Brian R Lee3
1Division of Infectious Diseases, Children's Mercy Kansas City, Kansas City, MO; University of Missouri Kansas City, Kansas City, MO.
Insights
Rapid influenza testing significantly impacts pediatric patient management in emergency departments. Accurate results guide treatment decisions and reduce unnecessary antiviral prescriptions, leading to cost savings.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Disease Diagnostics
- Clinical Management
Background:
- Influenza diagnosis in pediatric emergency departments (EDs) and urgent care clinics relies on clinical suspicion, which is often inaccurate.
- Rapid influenza diagnostic tests are crucial for timely and effective patient care.
Purpose of the Study:
- To evaluate the impact of rapid influenza real-time qualitative reverse transcriptase polymerase chain reaction (RT-PCR) on patient management in pediatric EDs and urgent care settings.
- To assess how RT-PCR results influence clinical decisions regarding treatment and antiviral use.
Main Methods:
- A prospective survey was administered to clinicians ordering influenza RT-PCR in EDs and urgent care clinics.
- Data collected included clinical suspicion, intended management, and actual management post-RT-PCR results.
- 339 patient encounters were analyzed.
Main Results:
- Influenza RT-PCR positivity was 48.4%; clinical suspicion was not a significant predictor.
- Clinicians altered management plans in 44.5% of positive and 92.6% of negative RT-PCR cases.
- Negative RT-PCR results led to 135 avoided antiviral prescriptions, with significant changes in antiviral use plans (77% vs. 26%).
Conclusions:
- Rapid influenza RT-PCR is essential for accurate diagnosis and improved management of pediatric influenza in acute care settings.
- Negative RT-PCR results effectively reduce unnecessary antiviral prescriptions, offering potential for significant cost savings.
- Clinical suspicion alone is insufficient for accurate influenza diagnosis in children.
Objectives:
To measure the impact of rapid influenza real-time qualitative reverse transcriptase polymerase chain reaction (RT-PCR) on patient management in busy pediatric emergency department (ED) and urgent care clinic settings.
Study Design:
We developed a brief, elective survey that clinicians completed when an influenza RT-PCR order was placed in the ED or urgent care clinic between February 18, 2019, and March 13, 2019. We captured the clinical suspicion for influenza, intended management plans, and actual management plans once influenza RT-PCR results were available.
Results:
We evaluated 339 encounters, of which 164 (48.4%) had a positive influenza RT-PCR. Clinical suspicion for influenza was a nonsignificant predictor for influenza PT-PCR positivity (P = .126). After rapid influenza RT-PCR results were available, clinicians changed their original plans in 44.5% of influenza RT-PCR positive vs 92.6% of influenza RT-PCR negative cases (P < .0001). Change in plans for antiviral use was observed in 26% of influenza positive vs 77% of influenza negative cases (P < .0001). A total of 135 antiviral prescriptions were avoided in patients with negative influenza RT-PCR.
Conclusions:
Implementation of a rapid and accurate influenza RT-PCR in the acute care setting is important to systematically diagnose influenza in children and improve outpatient management decisions, because clinical suspicion for influenza is inaccurate. A negative influenza RT-PCR decreases unnecessary antiviral use and has the potential for significant cost savings.
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