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Rapid Molecular Detection and Differentiation of Influenza Viruses A and B
Published on: January 30, 2017
Point-of-Care Influenza Testing in the Pediatric Emergency Department
Prina Patel1, Vincent Matt Laurich, Sharon Smith
1From the Department of Pediatric Emergency Medicine, Connecticut Children's Medical Center, Hartford, CT.
Insights
Introducing a rapid polymerase chain reaction-based influenza test reduced invasive testing and emergency department length of stay. Antiviral use increased, but antibiotic use remained unchanged, improving patient care during flu season.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Disease Diagnostics
- Clinical Pathology
Background:
- Influenza diagnosis in emergency departments often relies on clinical அறிகுறis, leading to potential overuse of diagnostic tests and treatments.
- Rapid diagnostic tests can expedite influenza diagnosis, potentially altering clinical management and resource utilization.
- The implementation of point-of-care (POC) testing offers a promising approach to improve efficiency in emergency care settings.
Purpose of the Study:
- To evaluate the impact of a rapid polymerase chain reaction-based influenza test on emergency department (ED) length of stay (LOS).
- To assess changes in the utilization of imaging, serum/urine testing, antibiotics, and antivirals post-implementation of POC influenza testing.
- To determine the clinical and resource implications of rapid influenza diagnostics in pediatric patients.
Main Methods:
- A retrospective audit of electronic health records for pediatric patients (3 months–18 years) presenting to the ED during peak influenza seasons (November-March) from 2014-2018.
- Comparison of clinical data between a pre-POC implementation period (2014-2017) and a post-POC implementation period (2017-2018).
- Inclusion criteria required patients to be tested for influenza during their ED visit.
Main Results:
- The post-POC period showed significantly lower rates of complete blood count (25.6% vs 44.7%), blood cultures (16.3% vs 30%), urine testing (12.2% vs 21.5%), and chest radiography (34.4% vs 47.5%) compared to the pre-POC period (P < 0.01 for all).
- No significant difference was observed in antibiotic utilization between the two periods.
- Oseltamivir (antiviral) use increased in the post-POC period (21.2% vs 13.3%, P < 0.05), and median ED LOS decreased from 239 to 232 minutes (P < 0.05).
Conclusions:
- Introduction of a PCR-based POC influenza test led to reduced rates of invasive blood work, urine studies, and imaging in the pediatric ED.
- The rapid test was associated with a decrease in median emergency department length of stay.
- Antiviral administration increased post-implementation, suggesting more targeted treatment, while antibiotic use remained stable.
Objectives:
To see what the impact of introducing a rapid polymerase chain reaction-based influenza test has on length of stay (LOS) in emergency department, use of imaging, serum or urine testing, antibiotic use, and antiviral use.
Methods:
Audit of electronic medical health records was performed for all emergency department visits from 2014 to 2018 between November and March, which was defined as peak flu season. Patients were included if they were between 3 months and 18 years of age, presented during peak flu season, and were tested for influenza. The pre-point of care (POC) period was defined as November through March of 2014 to 2017 which was compared with the post-POC group which was defined as November through March of 2017 to 2018.
Results:
Patients tested for influenza in the pre-POC period were more likely to have complete blood count testing (44.7% vs 25.6% P < 0.01), more likely to have blood cultures performed (30% vs 16.3%, P < 0.01), more likely to have urine testing performed (21.5% vs 12.2%, P < 0.01), and more likely to have a chest radiograph completed (47.5% vs 34.4%, P < 0.01). There was no significant difference in rates of antibiotics used. There was increased rates of oseltamivir used in the post-POC period (21.2% vs 13.3%, P < 0.05. The median LOS decreased from 239 minutes in the pre-POC period to 232 minutes in the post-POC period (P < 0.05).
Conclusions:
With the introduction of a polymerase chain reaction-based point-of-care influenza test, there were overall decreased rates of invasive blood work, urine studies, and imaging, and median LOS. There was also increased antiviral administration.
