Impact of Rapid Molecular Respiratory Virus Testing on Real-Time Decision Making in a Pediatric Emergency Department.
Acute respiratory illnesses (ARIs) are usually viral [influenza, respiratory syncytial virus (RSV)] and account for 25% of emergency department (ED) peak-season visits. Laboratory PCR testing is accurate albeit slow, whereas rapid antigen testing is inaccurate. We determined the impact of bedside PCR (molecular point-of-care test; mPOCT) on pediatric ARI management. This was a prospective cohort study of consecutive pediatric patients with ED-ordered respiratory PCR test, enrolled over 9 weeks during peak flu season. On ordering, ED physicians were interviewed to ascertain real-time plans if given immediate influenza/RSV PCR results for the current patient. Two groups were compared: actual management and management adjusted for mPOCT results. We compared ED length of stay (LOS), tests ordered, and antibiotic/antiviral ordering. One-hundred thirty-six respiratory PCR panels were ordered, 71 by admitting team, 61 for ED management. Of 61 ED-initiated tests, physicians indicated in 39 cases (64%) they would change patient management were bedside viral results available. Physicians would have decreased ED LOS by 33 minutes, ordered fewer tests (18%; P < 0.001) with average patient charge savings of $669, fewer antibiotics among discharged patients (17%; P = 0.043), and increased appropriate antiviral use (13%; P = 0.023). Rapid bedside ARI mPOCT PCR has the potential to decrease ED LOS, reduce diagnostic tests and patient charges, and increase appropriate use of antibiotics and antiviral agents.
Department of Health Research and Policy, Stanford University, Stanford, California.
Daniel T
DT
Rogan
Department of Emergency Medicine, Stanford University, Stanford, California.
Mohit S
MS
Kochar
Department of Emergency Medicine, Stanford University, Stanford, California. Electronic address: syang5@stanford.edu.
Samuel
S
Yang
Department of Emergency Medicine, Stanford University, Stanford, California. Electronic address: quinnj@stanford.edu.
James V
JV
Quinn
D002648:Child; D003657:Decision Making; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D009975:Orthomyxoviridae / Q000302:isolation & purification; D019095:Point-of-Care Systems; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification