Impact of rapid influenza diagnostic test on physician estimation of viral infection probability in paediatric emergency department during epidemic period |
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| Institution: | 1. CHU de Nantes, HME, Paediatric Emergency Department,Nantes, France;2. CHU de Nantes, Laboratory of Virology, Nantes, France;3. CHU de Nantes, HME, Paediatric Department, Nantes, France;4. Université de Nantes, Faculté de Médecine, Nantes, France;1. State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, PR China;2. Department of Environmental & Global Health, College of Public Health & Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA;3. Department of Disease Prevention and Control, Wuxi Center for Disease Control and Prevention, Wuxi 214023, PR China;1. University Children''s Hospital, Department of Child, Adolescent & Developmental Neurology, Bohori?eva 20, 1525 Ljubljana, Slovenia;2. Department of Pediatrics, General Hospital Slovenj Gradec, Gosposvetska cesta 1, 2380 Slovenj Gradec, Slovenia;3. Neurology Revita, Kidri?eva 47a, 4000 Kranj, Slovenia;1. Private Practice, Seattle, WA 98102, USA;2. Emory University, Atlanta, GA, USA;3. University of Melbourne, Melbourne, VIC, Australia;4. University of Colorado School of Medicine, Aurora, CO, USA;1. Unidad de Fatiga Crónica, Servicio de Psicología, Hospital Clínic, Instituto de Neurociencias, Universitat de Barcelona, Barcelona, España;2. Sección de Toxicología, Servicio de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España;3. Servicio de Psicología, Hospital Clínic, Instituto de Neurociencias, Universitat de Barcelona, Barcelona, España;4. Unidad de Fatiga Crónica, Servicio de Medicina Interna, Hospital Clínic, Universitat de Barcelona, Barcelona, España |
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| Abstract: | BackgroundThe clinical diagnosis of influenza is difficult in the younger children.ObjectivesEvaluate the impact of rapid influenza diagnostic test (RIDT) on clinicians’ estimation of the clinical probability of influenza in children.Study designThis prospective study included children aged from 1 month to 5 years who were admitted in a university paediatric emergency department during an influenza epidemic period and presented with fever without source. The RIDT Quickvue® was performed on nasopharyngeal aspiration and results were confirmed with immunofluorescence and/or PCR. The clinical probability of influenza and serious bacterial infection (SBI) was evaluated for each child before and after the physician(s) was informed of the RIDT results.Results170 children were included from January 15th through March 18th, 2013. After the only clinical examination, the overall clinical probability of influenza was 66.0% CI 95%: 63.04–68.4], and was significantly increased at 92.4% CI 95%: 89.5–95.3] in case of positive RIDT and significantly decreased at 30.8% CI 95%: 29.0–32.5] in case of negative RIDT without knowing the results of laboratory tests. Whereas the initial clinical probability of influenza were appropriate regarding the prevalence (66.0% vs. 57.0%), the probability of SBI was overestimated (30.2% vs. 8.8%). The RIDT result positive enabled a significant decrease in orders for chest X-rays (64,4% vs. 45.8%, p < 0,05) and laboratory tests (71,1% vs. 41.1%, p < 0,05).ConclusionsThe RIDT seems to be a useful diagnostic tool for ED clinicians in epidemic conditions. Improving clinician estimation of flu probability would reduce orders for imaging and testing. |
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| Keywords: | Children Rapid influenza diagnostic test (RIDT) Diagnosis probability Fever without source influenza Paediatric emergency department |
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