Impact des tests de diagnostic rapide de la grippe dans la prise en charge des enfants en période d’épidémie en pédiatrie de ville

Abstract

Objective Several studies have highlighted the assets of the influenza rapid diagnostic tests (IRDT) for the emergency department management of febrile children. The objective of this study was to determine in ambulatory pediatric setting impact of IRDT on the management of febrile children during an epidemic, especially on other diagnostic testing performed, antibiotic and antiviral treatments. Methods During an influenza epidemic, 37 paediatricians in three different areas of France included all children presenting fever with respiratory illnesses; they performed IRDT (test QuickVue ® for Influenza A and B, Quidel). Data collected were antiflu vaccination, previous asthma, symptoms, clinical signs, other diagnostic testing performed, and a follow-up two weeks later. Results Between December, 2006 and April, 2007, 695 children entered the program. The average age of those children was 4.1 years old (SD 3.4), median 3.2 (0.07–17.5). In 41.6% of the cases, the tests proved positive. Among 13 symptoms of influenza, only five were significantly more present in the group IRDT+: shiver (68.1% versus 57.4%), asthenia (87% versus 79.9%), cough (87.5% versus 70.1%), rhinorrhea (93.4% versus 83.3%), and sleepiness (54.2% versus 43.4%). The number of laboratory tests and radiographs ordered were less frequent in group IRDT+ than in group IRDT-: respectively 0.7% versus 11.6%, and 0.7% versus 8.6% ( p < 0.0001). IRDT+ group received antibiotics in 7.6% of cases (22 patients, 20 for OMA) and antiviral in 64.7%. IRDT- group received respectively 18.5% antibiotics, and no antiviral ( p < 0.0001). Conclusion This study confirms the difficulty of clinical influenza diagnosis, and suggests the assets of IRDT to diagnose influenza and to improve the management of influenza in ambulatory paediatric setting.