title: Impact of rapid influenza diagnostic test on physician estimation of viral infection probability in paediatric emergency department during epidemic period.
abstract: BACKGROUND
  The clinical diagnosis of influenza is difficult in the younger children.
  
  
  OBJECTIVE
  Evaluate the impact of rapid influenza diagnostic test (RIDT) on clinicians' estimation of the clinical probability of influenza in children.
  
  
  METHODS
  This 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.
  
  
  RESULTS
  170 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).
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: CHU de Nantes, HME, Paediatric Emergency Department,Nantes, France. Electronic address: sylvie.lacroix@chu-nantes.fr.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Lacroix
authors.affiliation: CHU de Nantes, HME, Paediatric Emergency Department,Nantes, France.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Vrignaud
authors.affiliation: CHU de Nantes, HME, Paediatric Emergency Department,Nantes, France.
authors.forename: Estelle
authors.initials: E
authors.lastname: Avril
authors.affiliation: CHU de Nantes, Laboratory of Virology, Nantes, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Moreau-Klein
authors.affiliation: CHU de Nantes, Laboratory of Virology, Nantes, France.
authors.forename: Marianne
authors.initials: M
authors.lastname: Coste
authors.affiliation: CHU de Nantes, HME, Paediatric Department, Nantes, France; Université de Nantes, Faculté de Médecine, Nantes, France.
authors.forename: Elise
authors.initials: E
authors.lastname: Launay
authors.affiliation: CHU de Nantes, HME, Paediatric Emergency Department,Nantes, France; CHU de Nantes, HME, Paediatric Department, Nantes, France; Université de Nantes, Faculté de Médecine, Nantes, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Gras-Le Guen
mesh_terms: D002675:Child, Preschool; D002846:Chromatography, Affinity / Q000379:methods*; D003955:Diagnostic Tests, Routine / Q000379:methods*; D004635:Emergency Medicine / Q000379:methods*; D004636:Emergency Service, Hospital; D058872:Epidemics; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007251:Influenza, Human / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D010820:Physicians; D019095:Point-of-Care Systems; D011446:Prospective Studies
keywords: Children; Diagnosis probability; Fever without source; Paediatric emergency department; Rapid influenza diagnostic test (RIDT); influenza