Early rapid diagnostic viral tests in the emergency department setting

Abstract

Doan et al from Vancouver, British Columbia, performed a prospective, randomized, controlled intervention trial of performance of multi-viral rapid diagnostic testing in children 3 to 36 months of age brought to the emergency department (ED) with febrile respiratory tract illnesses. Testing in the treatment group was performed at the time of triage (before evaluation by a physician), and results were recorded on the patient's chart. Outcomes assessed in the intervention and control groups were ED tests ordered, length of stay, prescription of an antibiotic, and then post-ED visit to a medical provider, performance of ancillary test(s), and prescription of an antibiotic. With 200 children's data analyzed, the only outcome measure significantly affected by early, rapid testing was reduction in prescription of an antibiotic after ED discharge. It is possible that several caveats of the study design and performance “washed out” other potential beneficial effects of early testing for a viral etiology of illness (eg, number of test results not back before ED discharge in the intervention group, tests ordered by physician's choice in the control group). Multi-viral rapid testing (RSV, influenza, parainfluenza, and adenovirus) confirmed viral etiology in > 60% of subjects in this study. Even if the decrease in antibiotic prescriptions subsequent to the ED visit was the only benefit of testing, it raises a possible new strategy in the battle against overuse of antibiotics.