title: Diagnostic performance of influenza viruses and RSV rapid antigen detection tests in children in tertiary care.
abstract: Rapid antigen detection tests (RADTs) are increasingly used to detect influenza viruses and respiratory syncytial virus (RSV). However, their sensitivity and specificity are a matter of debate, challenging their clinical usefulness.
  
  
  
  Comparing diagnostic performances of BinaxNow Influenza AB(®) (BNI) and BinaxNow RSV(®) (BNR), to those of real-time reverse transcriptase PCR (RT-PCR), virus isolation and direct immunofluorescence (D-IF) in paediatric patients.
  
  
  
  Between November 2005 and September 2013, 521 nasal washings from symptomatic children (age <5 years) attending our tertiary care centre were tested, with a combination of the respective assays using RT-PCR as gold standard.
  
  
  
  Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of BNI were 69% (confidence interval [CI] [51-83]), 96% [94-97], 55% [39-70] and 98% [96-99] respectively. Of eleven false-negative samples, RT-PCR Ct-values were higher than all RT-PCR positive test results (27 vs 22, p=0.012). Of twenty false-positive samples, none were culture positive and two tested positive in D-IF. Sensitivity, specificity, PPV and NPV for BNR were 79% [73-85], 98% [96-99], 97% [93-99] and 88% [84-91]. Of the 42 false-negative samples the median Ct-value was higher than that of all RT-PCR positive samples (31 vs 23, p<0.0001). Five false-positive samples were detected. Three of these tested positive for RSV in virus isolation and D-IF.
  
  
  
  RADTs have a high specificity with BNR being superior to BNI. However, their relative low sensitivity limits their usefulness for clinical decision making in a tertiary care paediatric hospital.
authors.affiliation: Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: F M
authors.initials: FM
authors.lastname: Moesker
authors.affiliation: Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: J J A
authors.initials: JJA
authors.lastname: van Kampen
authors.affiliation: Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Aron
authors.affiliation: Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands; Viroclinics Biosciences BV, Rotterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Schutten
authors.affiliation: Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: D A M C
authors.initials: DAMC
authors.lastname: van de Vijver
authors.affiliation: Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: M P G
authors.initials: MPG
authors.lastname: Koopmans
authors.affiliation: Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands; Viroclinics Biosciences BV, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine, Hannover, Germany. Electronic address: Albert.Osterhaus@tiho-hannover.de.
authors.forename: A D M E
authors.initials: ADME
authors.lastname: Osterhaus
authors.affiliation: Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands; Department of Paediatrics, Erasmus MC-Sophia, Rotterdam, The Netherlands.
authors.forename: P L A
authors.initials: PLA
authors.lastname: Fraaij
mesh_terms: D000956:Antigens, Viral / Q000032:analysis*; D002675:Child, Preschool; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007251:Influenza, Human / Q000175:diagnosis*; D008297:Male; D009975:Orthomyxoviridae; D011237:Predictive Value of Tests; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D063128:Tertiary Health Care / Q000379:methods*; D013997:Time Factors
chemical_list: D000956:Antigens, Viral
keywords: Influenza; Paediatrics; Rapid antigen detection tests; Respiratory syncytial virus; Tertiary care