摘要
Objective:To determine whether a point-of-care rapid influenza test impacts the diagnostic evaluation and treatment of children with acute respiratory illnesses. Design:Randomized controlled trial. Setting:Pediatric emergency department and acute care clinic of a children’s hospital. Participants:Children aged younger than 5 years with fever or acute respiratory symptoms during 2 influenza seasons (2002 through 2004). Interventions:Surveillance days were randomized to performance or no performance of a point-of-care rapid influenza test. All children had a nasal and throat swab obtained for laboratory tests. The rapid testgroup had another nasal swab obtained for the QuickVue Influenza Test(Quidel Corp,San Diego,Calif),which was performed by nurses; results were shared immediately with treating physicians.Main Outcome Measures:Rapid test results were compared with results of the viral culture or 2 polymerase chain reaction assays for influenza. Diagnostic test ordering and antibiotic prescribing were compared for the groups. Results:Of 468 enrolled children,306 were from the emergency department and 162 from the clinic. Overall,88 children(19%) had influenza infection. Of 205 children in the rapid test group,51 (25%) had influenza infection. The rapid influenza test was 82%sensitive and 99%specific. In the emergency department,fewer children in the rapid test group had diagnostic tests ordered than in the no rapid test group(39%vs 51%,P=0.03). There was no difference in test ordering in the clinic or in antibiotic prescribing in either setting.The use of antivirals was low. Conclusions:Point-of-care rapid influenza tests were sensitive and specific and were associated with less diagnostic testing in the emergency department.
Objective:To determine whether a point-of-care rapid influenza test impacts the diagnostic evaluation and treatment of children with acute respiratory illnesses. Design:Randomized controlled trial. Setting:Pediatric emergency department and acute care clinic of a children's hospital. Participants:Children aged younger than 5 years with fever or acute respiratory symptoms during 2 influenza seasons (2002 through 2004). Interventions:Surveillance days were randomized to performance or no performance of a point-of-care rapid influenza test. All children had a nasal and throat swab obtained for laboratory tests. The rapid testgroup had another nasal swab obtained for the QuickVue Influenza Test(Quidel Corp,San Diego,Calif),which was performed by nurses; results were shared immediately with treating physicians.Main Outcome Measures:Rapid test results were compared with results of the viral culture or 2 polymerase chain reaction assays for influenza. Diagnostic test ordering and antibiotic prescribing were compared for the groups. Results:Of 468 enrolled children,306 were from the emergency department and 162 from the clinic. Overall,88 children(19%) had influenza infection. Of 205 children in the rapid test group,51 (25%) had influenza infection. The rapid influenza test was 82%sensitive and 99%specific. In the emergency department,fewer children in the rapid test group had diagnostic tests ordered than in the no rapid test group(39%vs 51%,P=0.03). There was no difference in test ordering in the clinic or in antibiotic prescribing in either setting.The use of antivirals was low. Conclusions:Point-of-care rapid influenza tests were sensitive and specific and were associated with less diagnostic testing in the emergency department.
