Utility of early influenza diagnosis through point‐of‐care testing in children presenting to an emergency department
- 1 April 2016
- journal article
- research article
- Published by Wiley in Journal of Paediatrics and Child Health
- Vol. 52 (4), 422-429
- https://doi.org/10.1111/jpc.13092
Abstract
Aim Influenza causes a large burden of disease in children. Point‐of‐care testing (POCT) can rapidly diagnose influenza with the potential to reduce investigation and hospital admission rates, but information on its use in an Australian setting is limited. Methods Through a retrospective review of laboratory‐confirmed influenza cases presenting at a paediatric emergency department (ED) in 2009, we evaluated children diagnosed by POCT versus standard testing (direct fluorescent antibody, polymerase chain reaction or viral culture) and assessed differences in investigations, admission requirements, length‐of‐stay (LOS) in ED/hospital and antibiotic/antiviral prescription. The rate of serious bacterial infection was examined. Results Compared with standard testing (n = 65), children diagnosed by positive POCT (n = 236) had a shorter median hospital LOS by 1 day (P = 0.006), increased antiviral prescription (odds ratio 3.31, P < 0.001) and a reduction in the time to influenza diagnosis (2.4 vs. 24.4 h, P < 0.001); however, a negative POCT result (n = 63) resulted in delayed diagnosis (44.0 h, P = 0.001). POCT did not decrease LOS in ED. Interpretation of reductions in admission and investigations with POCT may be limited by possible confounding. Approximately 4% of influenza patients had a serious bacterial infection; urinary tract infections were commonest (2.7%), but no cerebrospinal fluid cultures were positive. A single positive blood culture was seen among 332 immunocompetent influenza patients. Conclusions Influenza diagnosis by POCT was quicker and reduced LOS of hospitalised children, whereas negative results delayed diagnosis. Negative POCT should not alter usual investigations if influenza remains suspected. A controlled prospective study during the influenza season is needed to clarify the direct benefits of POCT.Keywords
Funding Information
- National Health and Medical Research Council (633028)
This publication has 24 references indexed in Scilit:
- Burden of paediatric influenza in Western Europe: a systematic reviewBMC Public Health, 2012
- High Sensitivity of a Rapid Immunochromatographic Test for Detection of Influenza A Virus 2009 H1N1 in Nasopharyngeal Aspirates from Young ChildrenJournal of Clinical Microbiology, 2010
- The burden of influenza in children under 5 years admitted to the Children's Hospital at Westmead in the winter of 2006Journal of Paediatrics and Child Health, 2009
- Influenza Virus Infection and the Risk of Serious Bacterial Infections in Young Febrile InfantsPEDIATRICS, 2009
- 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 IllnessesThe Journal of Pediatrics, 2009
- Influenza Burden in Febrile Infants and Young Children in a Pediatric Emergency DepartmentThe Pediatric Infectious Disease Journal, 2007
- Impact of Rapid Viral Testing for Influenza A and B Viruses on Management of Febrile Infants Without Signs of Focal InfectionThe Pediatric Infectious Disease Journal, 2006
- Effect of Point-of-care Influenza Testing on Management of Febrile ChildrenAcademic Emergency Medicine, 2006
- Retrospective Review of Serious Bacterial Infections in Infants Who Are 0 to 36 Months of Age and Have Influenza A InfectionPEDIATRICS, 2005
- Effect of a rapid influenza diagnosisArchives of Disease in Childhood, 2003