title: 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.
abstract: OBJECTIVE
  Acute respiratory tract infections represent a significant burden on pediatric emergency departments (ED) and families. We hypothesized that early and rapid diagnosis of a viral infection alleviates the need for ancillary testing and antibiotic treatment.
  
  
  METHODS
  We conducted a randomized, controlled trial of children 3 to 36 months of age with febrile acute respiratory tract infections at a pediatric ED. Two hundred four subjects were randomly assigned to receive rapid respiratory viral testing on admission or a routine ED admission protocol. Outcome measures were: mean length of visits, rate of ancillary tests, and antibiotic prescription in the ED. A follow-up call was made to all study subjects to inquire about further healthcare visits, ancillary testing, and antibiotic prescription after ED discharge.
  
  
  RESULTS
  We did not find a statistically significant difference in ED length of visits, rate of ancillary testing, or antibiotic prescription rate in the ED between the study groups. There was, however, a significant reduction in antibiotic prescription after ED discharge (in the group who had rapid viral testing RR = 0.36; 95% CI = 0.14, 0.95).
  
  
  CONCLUSIONS
  Rapid multi-viral testing in the ED did not significantly affect ED patient treatment but may reduce antibiotic prescription in the community after discharge from the ED, suggesting a novel strategy to alter community physician antibiotic prescription patterns.
authors.affiliation: Pediatric Emergency Department, BC Children's Hospital, Vancouver, British Columbia, Canada. qdoan@cw.bc.ca
authors.forename: Quynh H
authors.initials: QH
authors.lastname: Doan
authors.forename: Niranjan
authors.initials: N
authors.lastname: Kissoon
authors.forename: Simon
authors.initials: S
authors.lastname: Dobson
authors.forename: Sandy
authors.initials: S
authors.lastname: Whitehouse
authors.forename: Doug
authors.initials: D
authors.lastname: Cochrane
authors.forename: Brian
authors.initials: B
authors.lastname: Schmidt
authors.forename: Eva
authors.initials: E
authors.lastname: Thomas
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001955:British Columbia; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012107:Research Design; D012141:Respiratory Tract Infections / Q000821:virology*; D014777:Virus Diseases / Q000175:diagnosis*
chemical_list: D000900:Anti-Bacterial Agents