title: Impact of a rapid respiratory panel test on patient outcomes.
abstract: BACKGROUND
  Evolution of polymerase chain reaction testing for infectious pathogens has occurred concurrent with a focus on value-based medicine.
  
  
  OBJECTIVE
  To determine if implementation of the FilmArray rapid respiratory panel (BioFire Diagnostics, Salt Lake City, Utah) (hereafter RRP), with a shorter time to the test result and expanded panel, results in different outcomes for children admitted to the hospital with an acute respiratory tract illness.
  
  
  METHODS
  Patient outcomes were compared before implementation of the RRP (November 1, 2011, to January 31, 2012) versus after implementation of the RRP (November 1, 2012, to January 31, 2013). The study included inpatients 3 months or older with an acute respiratory tract illness, most admitted through the emergency department. Testing before RRP implementation used batched polymerase chain reaction analysis for respiratory syncytial virus and influenza A and B, with additional testing for parainfluenza 1 through 3 in approximately 11% of patients and for human metapneumovirus in less than 1% of patients. The RRP tested for respiratory syncytial virus, influenza A and B, parainfluenza 1 through 4, human metapneumovirus, adenovirus, rhinovirus/enterovirus, and coronavirus NL62.
  
  
  RESULTS
  The pre-RRP group had 365 patients, and the post-RRP group had 771 patients. After RRP implementation, the mean time to the test result was shorter (383 minutes versus 1119 minutes, P < .001), and the percentage of patients with a result in the emergency department was greater (51.6% versus 13.4%, P < .001). There was no difference in whether antibiotics were prescribed, but the duration of antibiotic use was shorter after RRP implementation (P = .003) and was dependent on receiving test results within 4 hours. If the test result was positive, the inpatient length of stay (P = .03) and the time in isolation (P = .03) were decreased after RRP implementation compared with before RRP implementation.
  
  
  CONCLUSIONS
  The RRP decreases the duration of antibiotic use, the length of inpatient stay, and the time in isolation.
authors.affiliation: From the Departments of Pathology (Drs Rogers and Jerris and Ms Uwindatwa), Pediatrics (Drs Kotzbauer and Anderson), Infection Control (Ms Watson), and Statistics (Drs O'Brien and Bost and Ms McNamara), Children's Healthcare of Atlanta; and Departments of Pathology (Drs Rogers and Jerris), Medicine (Dr Shankar), and Pediatrics (Dr Anderson), Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Beverly B
authors.initials: BB
authors.lastname: Rogers
authors.forename: Prabhu
authors.initials: P
authors.lastname: Shankar
authors.forename: Robert C
authors.initials: RC
authors.lastname: Jerris
authors.forename: David
authors.initials: D
authors.lastname: Kotzbauer
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Anderson
authors.forename: J Renee
authors.initials: JR
authors.lastname: Watson
authors.forename: Lauren A
authors.initials: LA
authors.lastname: O'Brien
authors.forename: Francine
authors.initials: F
authors.lastname: Uwindatwa
authors.forename: Kelly
authors.initials: K
authors.lastname: McNamara
authors.forename: James E
authors.initials: JE
authors.lastname: Bost
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003710:Demography; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D060888:Real-Time Polymerase Chain Reaction; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014777:Virus Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D014780:Viruses / Q000145:classification / Q000302:isolation & purification*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents