title: Diagnostic performance and clinical feasibility of a point-of-care test for respiratory viral infections in primary health care.
abstract: Inappropriately high levels of antibiotics are still prescribed in primary health care for respiratory tract infections (RTIs). Access to diagnostic point-of-care tests (POCTs) for RTIs might reduce this over-prescription.
  
  
  
  The purpose of our study was to determine the diagnostic performance and clinical feasibility of a recently developed diagnostic POCT for respiratory viruses, the mariPOC®, in a Dutch primary healthcare setting.
  
  
  
  In patients with RTI symptoms presenting to a family practice during the 2015-2016 winter season, we determined the test's sensitivity and specificity relative to polymerase chain reaction (PCR) testing performed in a laboratory. The clinical feasibility of the POCT was evaluated by interviewing general practitioners (GPs).
  
  
  
  One or more respiratory viruses were detected in 54.9% of the patients (n = 204). For influenza A virus (n = 24), sensitivity of the POCT was 54.2% and specificity was 98.9%; for influenza B virus (n = 18), sensitivity was 72.2% and specificity 99.5%; and for respiratory syncytial virus (RSV) (n = 12), sensitivity was 50.0% and specificity 100%. In samples with higher viral load, sensitivity was 85.7% for influenza A, 78.6% for influenza B and 85.7% for RSV. The availability of a diagnostic test for respiratory viruses was appreciated by both patients and GPs.
  
  
  
  Our study shows that diagnostic POCTs for respiratory viruses might contribute to a precise and evidence-based diagnosis of RTIs and could positively influence prescription of antibiotics by GPs. However, before implementation in primary healthcare, diagnostic accuracy of the POCT needs improvement and it is impact on clinical decision making should be further assessed.
authors.affiliation: Department of Pediatric Infectious Diseases and Immunology, Emma Children's Hospital, Academic Medical Center (AMC), Amsterdam, The Netherlands.
authors.forename: Andrea H L
authors.initials: AHL
authors.lastname: Bruning
authors.affiliation: Department of Pediatric Infectious Diseases and Immunology, Emma Children's Hospital, Academic Medical Center (AMC), Amsterdam, The Netherlands.
authors.forename: Wilhelmina B
authors.initials: WB
authors.lastname: de Kruijf
authors.affiliation: Department of General Practice, AMC, Amsterdam, The Netherlands.
authors.forename: Henk C P M
authors.initials: HCPM
authors.lastname: van Weert
authors.affiliation: Health Center Gein, GAZO, Amsterdam, The Netherlands.
authors.forename: Wim L M
authors.initials: WLM
authors.lastname: Willems
authors.affiliation: Department of Medical Microbiology, AMC, Amsterdam, The Netherlands.
authors.forename: Menno D
authors.initials: MD
authors.lastname: de Jong
authors.affiliation: Department of Pediatric Infectious Diseases and Immunology, Emma Children's Hospital, Academic Medical Center (AMC), Amsterdam, The Netherlands.
authors.forename: Dasja
authors.initials: D
authors.lastname: Pajkrt
authors.affiliation: Department of Medical Microbiology, AMC, Amsterdam, The Netherlands.
authors.forename: Katja C
authors.initials: KC
authors.lastname: Wolthers
mesh_terms: D000328:Adult; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control; D009980:Influenza A virus / Q000302:isolation & purification; D009981:Influenza B virus / Q000302:isolation & purification; D007251:Influenza, Human / Q000175:diagnosis / Q000821:virology; D008297:Male; D009426:Netherlands; D019095:Point-of-Care Systems / Q000706:statistics & numerical data*; D011320:Primary Health Care; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000821:virology; D012621:Seasons; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
keywords: Point-of-care testing; primary health care; rapid testing; respiratory tract infection; respiratory virus