Effect of the influenza virus rapid antigen test on a physician's decision to prescribe antibiotics and on patient length of stay in the emergency department.

Hye Won Jeong,Woo Joo Kim,Jung Soo Park,Jung Yeon Heo,Benjamin J Cowling

doi:10.1371/journal.pone.0110978

Hye Won Jeong, Woo Joo Kim + Show 3 more

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https://doi.org/10.1371/journal.pone.0110978

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Journal: PloS one	Publication Date: Nov 6, 2014
Citations: 42	License type: CC BY 4.0

Affiliation: Chungbuk National University, Korea University

Abstract

BackgroundInfluenza virus infection is a common reason for visits to the emergency department (ED) during the influenza season. A rapid and accurate diagnosis of influenza virus infection is important to reduce unnecessary antibiotic prescription and to improve patient care. The aim of this study was to examine whether using the Influenza Virus Rapid Antigen Test (IVRAT) in the ED affects the decision to prescribe antibiotics or the length of hospital stay (LOS).MethodsData from patients suffering from an influenza-like illness (ILI) and who were discharged after visiting the ED at Chungbuk National University Hospital were reviewed over two influenza seasons: 2010–2011, when IVRAT was not used in the ED, and 2011–2012, when it was. The numbers of antibiotic prescriptions issued and the ED LOS during these two seasons were then compared.ResultsThe number of antibiotic prescriptions was significantly lower in 2011–2012 (54/216, 25.0%) than in 2010–2011 (97/221, 43.9%; P<0.01). However, the median ED LOS for patients in 2011–2012 was much longer than that of patients in 2010–2011 (213 minutes vs. 257 minutes; P<0.01). During the 2011–2012 influenza season, 73 ILI patients showed a positive IVRAT result whereas 123 showed a negative result. Upon discharge, antibiotics were given to 42/123 (34.1%) ILI patients with a negative IVRAT result, but to only 7/73 (9.6%) patients with a positive IVRAT result (P<0.01).ConclusionsPerforming IVRAT in the ED reduced the prescription of antibiotics to ILI patients discharged after ED care. However, the ED LOS for patients who underwent IVRAT was longer than that for patients who did not. Thus, performing IVRAT in the ED reduces the unnecessary prescription of antibiotics to ILI patients during the influenza season.

Highlights

Influenza virus infection is a common reason for visits to the emergency department (ED) during annual influenza epidemics
During the 2011–2012 influenza season, 448 influenza-like illness (ILI) patients visited the ED and 216 patients were discharged after ED care
We found that performing Influenza Virus Rapid Antigen Test (IVRAT) in the ED reduced the number of antibiotics prescriptions issued to ILI patients who were not hospitalized

Summary

Introduction

Influenza virus infection is a common reason for visits to the emergency department (ED) during annual influenza epidemics. The incidence of medically-attended illness (influenza-like illness (ILI) severe enough to cause the patient to seek medical care) in unvaccinated populations is estimated to be 10–20%, the rates can be as high as 40–50% [1,2,3]. Various techniques are available for the rapid diagnosis of influenza at the point-of-patient care [8]. Influenza virus infection is a common reason for visits to the emergency department (ED) during the influenza season. A rapid and accurate diagnosis of influenza virus infection is important to reduce unnecessary antibiotic prescription and to improve patient care. The aim of this study was to examine whether using the Influenza Virus Rapid Antigen Test (IVRAT) in the ED affects the decision to prescribe antibiotics or the length of hospital stay (LOS)

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