title: Utility of early influenza diagnosis through point-of-care testing in children presenting to an emergency department.
abstract: OBJECTIVE
  Influenza causes a large burden of disease in children. Point-of-care testing (POCT) can rapidly diagnose influenza with the potential to reduce investigation and hospital admission rates, but information on its use in an Australian setting is limited.
  
  
  METHODS
  Through a retrospective review of laboratory-confirmed influenza cases presenting at a paediatric emergency department (ED) in 2009, we evaluated children diagnosed by POCT versus standard testing (direct fluorescent antibody, polymerase chain reaction or viral culture) and assessed differences in investigations, admission requirements, length-of-stay (LOS) in ED/hospital and antibiotic/antiviral prescription. The rate of serious bacterial infection was examined.
  
  
  RESULTS
  Compared with standard testing (n = 65), children diagnosed by positive POCT (n = 236) had a shorter median hospital LOS by 1 day (P = 0.006), increased antiviral prescription (odds ratio 3.31, P < 0.001) and a reduction in the time to influenza diagnosis (2.4 vs. 24.4 h, P < 0.001); however, a negative POCT result (n = 63) resulted in delayed diagnosis (44.0 h, P = 0.001). POCT did not decrease LOS in ED. Interpretation of reductions in admission and investigations with POCT may be limited by possible confounding. Approximately 4% of influenza patients had a serious bacterial infection; urinary tract infections were commonest (2.7%), but no cerebrospinal fluid cultures were positive. A single positive blood culture was seen among 332 immunocompetent influenza patients.
  
  
  CONCLUSIONS
  Influenza diagnosis by POCT was quicker and reduced LOS of hospitalised children, whereas negative results delayed diagnosis. Negative POCT should not alter usual investigations if influenza remains suspected. A controlled prospective study during the influenza season is needed to clarify the direct benefits of POCT.
authors.affiliation: National Centre for Immunisation Research and Surveillance.|Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney.
authors.forename: Jean
authors.initials: J
authors.lastname: Li-Kim-Moy
authors.affiliation: National Centre for Immunisation Research and Surveillance.|Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney.
authors.forename: Fereshteh
authors.initials: F
authors.lastname: Dastouri
authors.affiliation: National Centre for Immunisation Research and Surveillance.|Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney.
authors.forename: Harunor
authors.initials: H
authors.lastname: Rashid
authors.affiliation: National Centre for Immunisation Research and Surveillance.|The Children's Hospital at Westmead.|Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney.
authors.forename: Gulam
authors.initials: G
authors.lastname: Khandaker
authors.affiliation: The Children's Hospital at Westmead.|Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney.|Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney.
authors.forename: Alison
authors.initials: A
authors.lastname: Kesson
authors.affiliation: The Children's Hospital at Westmead.
authors.forename: Mary
authors.initials: M
authors.lastname: McCaskill
authors.affiliation: National Centre for Immunisation Research and Surveillance.|The Children's Hospital at Westmead.|Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Wood
authors.affiliation: The Children's Hospital at Westmead.|Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney.|Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Jones
authors.affiliation: Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney.|Australian Paediatric Surveillance Unit, Sydney, New South Wales,, Australia.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Zurynski
authors.affiliation: National Centre for Immunisation Research and Surveillance.|The Children's Hospital at Westmead.|Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney.
authors.forename: Kristine
authors.initials: K
authors.lastname: Macartney
authors.affiliation: The Children's Hospital at Westmead.|Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney.|Australian Paediatric Surveillance Unit, Sydney, New South Wales,, Australia.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Elliott
authors.affiliation: National Centre for Immunisation Research and Surveillance.|The Children's Hospital at Westmead.|Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney.|Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney.
authors.forename: Robert
authors.initials: R
authors.lastname: Booy
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007251:Influenza, Human / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009517:New South Wales; D017063:Outcome Assessment, Health Care; D000067716:Point-of-Care Testing / Q000706:statistics & numerical data*; D012016:Reference Values; D012189:Retrospective Studies
chemical_list: D000998:Antiviral Agents
keywords: children; emergency department; influenza; point-of-care testing