Utility of Rapid Testing for Respiratory Viruses in the ED

Abstract

Emergency Medicine| April 01 2009 Utility of Rapid Testing for Respiratory Viruses in the ED AAP Grand Rounds (2009) 21 (4): 44. https://doi.org/10.1542/gr.21-4-44 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Utility of Rapid Testing for Respiratory Viruses in the ED. AAP Grand Rounds April 2009; 21 (4): 44. https://doi.org/10.1542/gr.21-4-44 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: fever, length of stay, rapid screening test, virus diseases, triage, emergency service, hospital, respiratory system Source: Doan QH, Kissoon N, Dobson S, et al. A randomized, controlled trial of the impact of early and rapid diagnosis of viral infections in children brought to an emergency department with febrile respiratory tract illnesses. J Pediatr. 2009;154(1):91–95; doi:10.1016/j.jpeds.2008.07.043 Investigators in the emergency department (ED) at British Columbia Children’s Hospital in Vancouver conducted a randomized, controlled trial evaluating the clinical impact of rapid testing for multiple respiratory viruses at triage in the ED during the winter months of 2004–05 and 2005–06. Eligible children were between 3–36 months of age, with a temperature =38.5°C and one or more symptoms of respiratory illness. Children were excluded if they had underlying chronic cardiac or respiratory conditions, immunosuppression, or severe respiratory distress. Enrolled children in the intervention group underwent testing for adenovirus, influenza A and B, parainfluenza viruses (1, 2, and 3), and respiratory syncytial virus (RSV). The turnaround time in the ED was 30–150 minutes. Children in the control group were evaluated by a physician first and, if requested, bedside viral testing was performed. Parents of participants received a follow-up telephone call 7–10 days after the visit to evaluate if ancillary testing and antibiotic usage occurred after their discharge. A total of 94 infants were in the intervention and 110 in the control group (mean age 16 months). Approximately two-thirds of children in the intervention group and tested children in the control group had positive tests for viruses. Although the intervention group spent on average 50.4 minutes less in the ED than the control group, this difference was not statistically significant. The two groups had similar rates of ancillary testing and prescribing of antibiotics in the ED. Children in the intervention group were less likely to receive antibiotics when subsequently seeing their primary care provider for the same illness within one week of discharge from the ED (5.6% vs 15.5%; RR=0.36; 95% CI, 0.14–0.95). In the subgroup analysis, children who were positive on any rapid viral testing (n=89) had a significantly shorter length of stay than those who were not tested or tested negative (n=143) (−69 minutes; 95% CI, −128 to −9). The authors conclude that while rapid multi-viral testing at ED triage did not significantly alter the ED course of therapy, a positive test result decreased antibiotic prescriptions by community providers in children with febrile respiratory illness. Dr. Stevenson has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Clinicians often face the challenge during the winter season of determining whether febrile infants and toddlers have a bacterial or viral respiratory tract infection. Previous literature has shown that the risk of severe bacterial infection among febrile infants more than three months of age is low in the presence of a viral infection.1,2 Investigators interested in the impact of rapid viral testing in the ED have focused primarily on the utility of single agent identification (influenza or RSV).3,... You do not currently have access to this content.