Effect of point-of-care influenza testing on management of febrile children
Effect of point-of-care influenza testing on management of febrile children
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DOI：
10.1197/j.aem.2006.07.026
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发表时间：
2006-12-01
影响因子：
4.4
通讯作者：
Ruddy, Richard M.
中科院分区：
文献类型：
--
作者：
Iyer, Srikant B.;Gerber, Michael A.;Ruddy, Richard M.
目的：根据流感暴发期间在儿科急诊科就诊的高热儿童的年龄和体温，确定流行性感冒的护理点检测(POCT)对医生管理的影响。方法：在流感暴发期间向儿科急诊科就诊的2-3个月大的体温为38摄氏度的患儿和3-24个月体温为39摄氏度的患儿参加一项前瞻性、准随机、对照试验。通过POCT或标准检测(ST)方法对入选患者进行流感检测。在实验室检测、胸片、抗生素使用、就诊相关费用、儿科急诊室住院时间、住院时间和儿科急诊室回访方面对两组进行了比较。根据测试方法(POCT或ST)和测试结果(阳性或阴性)，对得到的患者亚组进行了类似的分析。结果：在767名符合条件的患者中，700名(91%)完成了研究。POCT组和ST组在订购的实验室检查、获得的胸片、抗生素给药、住院、儿科急诊室回访、住院时间或就诊相关费用方面没有显著差异。在亚组分析中，POCT组和ST组流感试验阳性和阴性患者血培养的调整优势比(OR)分别为0.59%和0.71%(p=0.088)。在流感试验阳性到阴性的患者中，尿培养的调整OR值分别为0.46和0.67(P=0.005)。结论：当采用对所有在流感暴发期间向儿科急诊室提出的SRI高危患者进行流感检测的策略时，检测方法(POCT或ST)似乎不会显著改变医生的管理、费用或在儿科急诊室的住院时间。然而，如果考虑到检测方法和检测结果(阳性或阴性)的相互作用，流感POCT阳性与尿液分析和尿液培养订单的显著减少有关。
Objectives: To determine the effect of point-of-care testing (POCT) for influenza on the physician management of febrile children who are at risk for serious bacterial illness (SBI) on the basis of age and temperature and who are presenting to a pediatric emergency department (ED) during an influenza outbreak.Methods: Patients 2-3 months of age with temperature of >= 38 degrees C and patients 3-24 months of age with temperature of >= 39 degrees C who were presenting to a pediatric ED during an influenza outbreak were enrolled into a prospective, quasi-randomized, controlled trial. Influenza testing was performed on enrolled patients by either the POCT or the standard-testing (ST) methods. The two groups were compared in terms of laboratory testing, chest radiography, antibiotic use, visit-associated costs, pediatric ED lengths of stay, inpatient admission, and return visits to the pediatric ED. Similar analyses also were performed on the resulting subgroups of patients on the basis of method of testing (POCT or ST) and test result (positive or negative).Results: Of 767 eligible patients, 700 (91%) completed the study. No significant differences were demonstrated between the POCT and ST groups with respect to laboratory tests ordered, chest radiographs obtained, antibiotic administration, inpatient admission, return visits to the pediatric ED, lengths of stay, or visit-associated costs. In the subgroup analysis, the adjusted odds ratios (ORs) for blood culture in influenza test-positive to-negative patients were 0.59 and 0.71 in the POCT and ST groups, respectively (p = 0.088). The adjusted ORs for urine culture in influenza test-positive to-negative patients were 0.46 and 0.67 in the POCT and ST groups, respectively (p = 0.005).Conclusions: When using a strategy of performing influenza testing on all patients at risk for SRI who presented to a pediatric ED during an influenza outbreak, the method of testing (POCT or ST) did not appear to significantly alter physician management, cost, or length of stay in the pediatric ED. However, if the interaction of the method of testing and the test result (positive or negative) were considered, a positive POCT for influenza was associated with a significant reduction in orders for urinalyses and urine cultures.