Abstract
BackgroundPoint-of-care tests (POCT) for influenza A and B viruses and respiratory syncytial virus (RSV) were implemented in emergency departments of all hospitals in the Capital Region of Denmark in 2018.AimTo establish whether POC testing for influenza viruses or RSV is based on a valid respiratory symptom indication, whether changes in patient management based on a positive result are safe and whether syndromic POC testing may benefit patients with influenza or RSV.MethodsSamples from 180 children (< 18 years) and 375 adults tested using POCT between February and July 2018 were retested for 26 respiratory pathogens. Diagnosis, indication for POC testing, hospitalisation time, antimicrobial therapy and readmission or death within one month of testing were obtained from patient records.ResultsA valid indication for POC testing was established in 168 (93.3%) of children and 334 (89.1%) of adults. A positive POCT result significantly reduced antibiotic prescription and median hospitalisation time by 44.3 hours for adults and 14.2 hours for children, and significantly increased antiviral treatment in adults. Risk of readmission or death was not significantly altered by a positive result. Testing for 26 respiratory pathogens established that risk of coinfection is lower with increasing age and that POCT for adults should be restricted to the influenza and RSV season.ConclusionPositive POCT resulted in changed patient management for both children and adults, and was deemed safe. POCT for additional pathogens may be beneficial in children below 5 years of age and outside the influenza and RSV season.
Highlights
Over a dozen different platforms for target amplification-based point-of-care tests (POCT) are available through several different companies [1]
Children below 18 years accounted for 32.4% (180/555), adults between 18 and 65 years accounted for 37.8% (210/555), and elderly patients above 65 years accounted for 29.7% (165/555) (Table 1)
Median hospitalisation time for children was 13.5 hours (IQR: 0.0–39.7) and 33 (18.3%) of the children were treated with antimicrobial therapy initiated during hospital admission (Table 1)
Summary
Over a dozen different platforms for target amplification-based point-of-care tests (POCT) are available through several different companies [1]. Other studies reported that POC testing for respiratory pathogens does not significantly reduce prescription or duration of antibiotics [4,7,8,9,11], do not reduce hospitalisation time or defer admissions [7,8,9] and do not reduce the risk of death or readmission [4,7,8]. In January 2018, routine POC testing for influenza A and B viruses and human orthopneumovirus (formerly respiratory syncytial virus, RSV) was implemented at all hospital emergency departments in the Capital Region of Denmark. Point-of-care tests (POCT) for influenza A and B viruses and respiratory syncytial virus (RSV) were implemented in emergency departments of all hospitals in the Capital Region of Denmark in 2018. POCT for additional pathogens may be beneficial in children below 5 years of age and outside the influenza and RSV season
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