Impact of Rapid Influenza Molecular Testing on Management in Pediatric Acute Care Settings

J Pediatr. 2021 Jan;228:271-277.e1. doi: 10.1016/j.jpeds.2020.08.007. Epub 2020 Aug 20.

Abstract

Objectives: To measure the impact of rapid influenza real-time qualitative reverse transcriptase polymerase chain reaction (RT-PCR) on patient management in busy pediatric emergency department (ED) and urgent care clinic settings.

Study design: We developed a brief, elective survey that clinicians completed when an influenza RT-PCR order was placed in the ED or urgent care clinic between February 18, 2019, and March 13, 2019. We captured the clinical suspicion for influenza, intended management plans, and actual management plans once influenza RT-PCR results were available.

Results: We evaluated 339 encounters, of which 164 (48.4%) had a positive influenza RT-PCR. Clinical suspicion for influenza was a nonsignificant predictor for influenza PT-PCR positivity (P = .126). After rapid influenza RT-PCR results were available, clinicians changed their original plans in 44.5% of influenza RT-PCR positive vs 92.6% of influenza RT-PCR negative cases (P < .0001). Change in plans for antiviral use was observed in 26% of influenza positive vs 77% of influenza negative cases (P < .0001). A total of 135 antiviral prescriptions were avoided in patients with negative influenza RT-PCR.

Conclusions: Implementation of a rapid and accurate influenza RT-PCR in the acute care setting is important to systematically diagnose influenza in children and improve outpatient management decisions, because clinical suspicion for influenza is inaccurate. A negative influenza RT-PCR decreases unnecessary antiviral use and has the potential for significant cost savings.

Keywords: children; emergency department; influenza clinical suspicion; rapid influenza RT-PCR; survey; urgent care clinics.

MeSH terms

  • Child
  • Child, Preschool
  • DNA, Viral / analysis*
  • Emergency Service, Hospital*
  • Female
  • Humans
  • Infant
  • Influenza A virus / genetics*
  • Influenza, Human / diagnosis*
  • Influenza, Human / virology
  • Male
  • Molecular Diagnostic Techniques / methods*
  • Point-of-Care Systems*
  • ROC Curve
  • Retrospective Studies

Substances

  • DNA, Viral