Abstract
Introduction. The rapid antigen test (RAT) plays an important role in the Emergency Room (ER). In this study, we investigated the effect of the RAT for influenza on clinical practice in an emergency department.Methods. A retrospective chart review was conducted considering two periods, namely before and after the 2009 influenza pandemic. The rate of antibiotic administration, the use of blood sample tests, the use of simple chest X-rays, the rate of antibiotic administration according to the result of the RAT, and the duration of ER stay in the case of influenza-like illnesses were investigated for the two study periods considered.Results. The use of the RAT increased from 23.9% to 39.8% in influenza-like pediatric patients (p<0.05) and from 4.9% to 67.6% in adult patients (p<0.001). After the 2009 influenza pandemic, the number of cases of antibiotic administration, blood sample test and simple chest X-ray decreased by 19.0%, 46.2%, and 27.4%, respectively, in pediatric patients with the use of RAT. Among RAT-positive patients, after the 2009 influenza pandemic, none of the pediatric patients and only 3 of the adult patients (17.6%) were administered antibiotics. The duration of ER stay was longer in patients who underwent RAT than in those who did not.Conclusion. The increased use of RAT for influenza has led to a decrease in antibiotic administration and a reduction in additional diagnostic tests in influenza-like illnesses. However, the use of RAT has not contributed to a decrease in the duration of ER stay.
Highlights
The rapid antigen test (RAT) plays an important role in the Emergency Room (ER)
The increased use of RAT for influenza has led to a decrease in antibiotic administration and a reduction in additional diagnostic tests in influenza-like illnesses
With the 2009 influenza pandemic, the overcrowding of patients with influenza-like symptoms led to a chaotic crisis in emergency departments (EDs). [2,3] The signs and symptoms of influenza cannot be differentiated from those caused by other respiratory pathogens, which makes it challenging to diagnosis influenza accurately in the ED. [4,5,6]
Summary
The rapid antigen test (RAT) plays an important role in the Emergency Room (ER). We investigated the effect of the RAT for influenza on clinical practice in an emergency department. With the 2009 influenza pandemic, the overcrowding of patients with influenza-like symptoms led to a chaotic crisis in emergency departments (EDs). The rapid antigen test (RAT) played an important role in EDs during this time for a quick diagnosis of influenza. [7,8,9] In one study, the Actim Influenza A&B kit (Medix Biochemica, Joensuu, Finland) has been shown to be 90.0% sensitive for the detection of influenza A virus. [11,12,13] In this study, we investigated the effect of RAT for influenza on the proportion of antibiotic administration, additional diagnostic tests, and the length of stay (LOS) in the ED Lucas et al reported that the sensitivity and specificity for the detection of H1N1 was 20.0% and 99.0%, respectively, using the QuickVue Influenza A+B Test (Quidel), while other investigators have found its sensitivity to be higher than this value. [7,8,9] In one study, the Actim Influenza A&B kit (Medix Biochemica, Joensuu, Finland) has been shown to be 90.0% sensitive for the detection of influenza A virus. [10]
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