Impact of a Rapid Respiratory Panel Test on Patient Outcomes
Impact of a Rapid Respiratory Panel Test on Patient Outcomes
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DOI：
10.5858/arpa.2014-0257-oa
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发表时间：
2015-05-01
影响因子：
4.6
通讯作者：
Bost, James E.
中科院分区：
文献类型：
--
作者：
Rogers, Beverly B.;Shankar, Prabhu;Bost, James E.
背景-传染病病原体聚合酶链式反应检测的发展与基于价值的医学的关注同步进行。目的-确定实施FilmArray快速呼吸系统小组(犹他州盐湖城BioFire诊断公司)(以下简称RRP)是否会导致住院的急性呼吸道疾病儿童的不同结果。设计-比较RRP实施前(2011年11月1日至2012年1月31日)和RRP实施后(2012年11月1日至2013年1月31日)的不同结果。这项研究包括3个月或以上患有急性呼吸道疾病的住院患者，大多数人是通过急诊科入院的。在RRP实施前的检测使用了针对呼吸道合胞病毒和甲型和乙型流感的批量聚合酶链式反应分析，另外在大约11%的患者中进行了副流感1到3的检测，在不到1%的患者中进行了人类偏肺炎病毒的检测。RRP检测呼吸道合胞病毒、甲型和乙型流感、副流感1~4、人偏肺病毒、腺病毒、鼻病毒/肠道病毒和冠状病毒NL62。结果：RRP前365例，RRP后771例。实施RRP后，检测结果的平均时间更短(383分钟比1119分钟，P<；.001)，急诊科患者的结果百分比更高(51.6%比13.4%，P<；.001)。两组患者是否使用抗生素无差异，但RRP实施后抗生素使用时间较短(P=0.003)，且依赖于4小时内收到检测结果。如果检测结果为阳性，实施RRP后患者的住院时间(P=.03)和隔离时间(P=.03)较实施RRP前减少。结论：RRP减少了抗生素的使用时间、住院时间和隔离时间。
Context.-Evolution of polymerase chain reaction testing for infectious pathogens has occurred concurrent with a focus on value-based medicine.Objective.-To determine if implementation of the FilmArray rapid respiratory panel (BioFire Diagnostics, Salt Lake City, Utah) (hereafter RRP), with a shorter time to the test result and expanded panel, results in different outcomes for children admitted to the hospital with an acute respiratory tract illness.Design.-Patient outcomes were compared before implementation of the RRP (November 1, 2011, to January 31, 2012) versus after implementation of the RRP (November 1, 2012, to January 31, 2013). The study included inpatients 3 months or older with an acute respiratory tract illness, most admitted through the emergency department. Testing before RRP implementation used batched polymerase chain reaction analysis for respiratory syncytial virus and influenza A and B, with additional testing for parainfluenza 1 through 3 in approximately 11% of patients and for human metapneumovirus in less than 1% of patients. The RRP tested for respiratory syncytial virus, influenza A and B, parainfluenza 1 through 4, human metapneumovirus, adenovirus, rhinovirus/enterovirus, and coronavirus NL62.Results.-The pre-RRP group had 365 patients, and the post-RRP group had 771 patients. After RRP implementation, the mean time to the test result was shorter (383 minutes versus 1119 minutes, P < .001), and the percentage of patients with a result in the emergency department was greater (51.6% versus 13.4%, P < .001). There was no difference in whether antibiotics were prescribed, but the duration of antibiotic use was shorter after RRP implementation (P = .003) and was dependent on receiving test results within 4 hours. If the test result was positive, the inpatient length of stay (P = .03) and the time in isolation (P = .03) were decreased after RRP implementation compared with before RRP implementation.Conclusions.-The RRP decreases the duration of antibiotic use, the length of inpatient stay, and the time in isolation.