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Published on: January 30, 2017
Delayed Influenza Treatment in Children With False-Negative Rapid Antigen Test: A Retrospective Single-Center Study
Ji Young Lee1, Seung Hwan Baek1, Jong Gyun Ahn1,2
1Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.
Insights
Delays in antiviral treatment for children with false-negative rapid antigen tests (RAT) for influenza were observed. Prompt treatment is crucial for severe cases, even with initial negative RAT results.
Area of Science:
- Pediatric Infectious Diseases
- Diagnostic Accuracy in Virology
- Health Economics and Outcomes Research
Background:
- Influenza virus infections pose a significant health burden in children.
- Rapid antigen tests (RAT) are widely used for influenza diagnosis but can yield false-negative results.
- Delayed antiviral treatment in pediatric influenza cases can lead to poorer clinical outcomes.
Purpose of the Study:
- To investigate the delay in antiviral initiation for children with false-negative RAT results for influenza.
- To explore the association between delayed treatment and clinical outcomes in pediatric influenza.
- To conduct a medical cost-benefit analysis related to diagnostic and treatment strategies.
Main Methods:
- Retrospective single-center study of children (<10 years) hospitalized with influenza-like illness (ILI) over three influenza seasons (2016-2019).
- Defined RAT-false-negativity as RAT-negative and polymerase chain reaction (PCR)-positive results.
- Calculated turnaround time (TAT) from RAT prescription to antiviral administration and performed medical cost analysis.
Main Results:
- Of 1,430 patients, 2.4% were RAT-false-negative. Median TAT was 52.8 hours for false-negative cases vs. 4 hours for RAT-positive cases.
- A TAT of ≥24 hours was significantly associated with increased risk of severe influenza infection (OR, 6.8) and mechanical ventilation (OR, 16.2).
- Medical costs per ILI patient ranged from $11.7 to $187.3.
Conclusions:
- Antiviral treatment initiation is significantly delayed in pediatric influenza cases with false-negative RAT results.
- Findings support immediate antiviral treatment for children with suspected severe or progressive influenza, irrespective of initial RAT results.
- Optimizing diagnostic pathways and treatment initiation is critical for improving pediatric influenza management.
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.
