A Randomized, Controlled Trial of the Impact of Early and Rapid Diagnosis of Viral Infections in Children Brought to an Emergency Department with Febrile Respiratory Tract Illnesses

Doan, Quynh; Kissoon, Niranjan; Dobson, Simon; Whitehouse, Sandy; Cochrane, D. Douglas; Schmidt, Brian L.; Thomas, Eva

doi:10.1016/j.jpeds.2008.07.043

Cited by 61 publications

(82 citation statements)

References 17 publications

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“…This paper expands upon a 2014 systematic review, which assessed the effect of rapid viral diagnosis for children with acute febrile respiratory illness on a range of clinical outcomes including antibiotic use and length of hospital stay. The previous publication was a quantitative analysis of four randomised controlled trials, whereas this systematic review was a qualitative analysis of 30 studies, and thus, we were able to make vastly different conclusions.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of the impact of point‐of‐care testing for influenza on the outcomes of patients with acute respiratory tract infection

Egilmezer

Walker

Bakthavathsalam

et al. 2018

Reviews in Medical Virology

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Acute respiratory tract infections are a major cause of morbidity and mortality and represent a significant burden on the health care system. Laboratory testing is required to definitively distinguish infecting influenza virus from other pathogens, resulting in prolonged emergency department (ED) visits and unnecessary antibiotic use. Recently available rapid point-of-care tests (POCT) may allow for appropriate use of antiviral and antibiotic treatments and decrease patient lengths of stay. We undertook a systematic review to assess the effect of POCT for influenza on three outcomes: (1) antiviral prescription, (2) antibiotic prescription, and (3) patient length of stay in the ED. The databases Medline and Embase were searched using MeSH terms and keywords for influenza, POCT, antivirals, antibiotics, and length of stay. Amongst 245 studies screened, 30 were included. The majority of papers reporting on antiviral prescription found that a positive POCT result significantly increased use of antivirals for influenza compared with negative POCT results and standard supportive care. A positive POCT result also led to decreased antibiotic use. The results of studies assessing the effect of POCT on ED length of stay were not definitive. The studies assessed in this systematic review support the use of POCT for diagnosis of influenza in patients suffering an acute respiratory infection. Diagnosis using POCT may lead to more appropriate prescription of treatments for infectious agents. Further studies are needed to assess the effect of POCT on the length of stay in ED.

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Section: Discussionmentioning

confidence: 99%

Systematic review of the impact of point‐of‐care testing for influenza on the outcomes of patients with acute respiratory tract infection

Egilmezer

Walker

Bakthavathsalam

et al. 2018

Reviews in Medical Virology

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“…A second study randomized 204 children (3-36 months of age) presenting with febrile acute respiratory illness at an emergency department to rapid viral testing or routine care (which included rapid viral testing if specifically requested by the physician). 96 No difference was seen in length of visit, rate of ancillary testing, or prescription, although the number of post discharge antibiotic prescriptions was reduced in the group who had viral testing (relative risk 0.36; 95% confidence interval 0.14 to 0.95). Two retrospective record review studies showed a reduction in antibiotic usage in children who received rapid viral testing.…”

Section: Value Of Different Specimen Types and Associated Diagnostic mentioning

confidence: 92%

“…Serological testing of blood specimens may be useful for epidemiological studies of the cause of pneumonia, where comparison of acute and convalescent titers may help identify the causative agent, [93][94][95][96][97][98][99][100][101][102][103][104][105][106][107][108][109][110][111][112] although the diagnostic value of a single specimen collected in the acute phase of the illness is generally limited. Pertussis serology may be a useful complementary diagnostic tool in older children and during the later phases of illness.…”

Section: Emerging Diagnosticsmentioning

confidence: 99%

Advances in the diagnosis of pneumonia in children

Zar

Andronikou

Nicol

2017

BMJ

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Pneumonia remains a major cause of childhood mortality and morbidity globally. Accurate diagnosis and attribution of the causes of pneumonia are important for measuring the burden of disease, implementing appropriate preventive or treatment strategies, and developing more effective interventions. This review summarizes recent diagnostic advances in radiological techniques, specimen collection, and laboratory methods. Although chest ultrasound and chest magnetic resonance imaging are promising modalities for radiological diagnosis, their role in clinical management and their impact on outcomes need further study. Rapid, highly sensitive, multiplex laboratory tests performed on upper respiratory tract samples or induced sputum can detect nucleic acid from potential pathogens in most children with pneumonia. However, it may be difficult to attribute causality because it is often impossible to distinguish between organisms colonizing or infecting the upper respiratory tract and those causing pneumonia. Currently available host biomarkers lack accuracy for distinguishing bacterial or mixed bacterial-viral infections from viral infections. New biomarkers derived from host transcriptional profile analysis may be more accurate but require validation. Prospective studies with appropriate control populations, including studies of clinical impact, are needed to improve our understanding of the role of tests. Although progress has been made in radiological techniques and laboratory testing, current methods for diagnosing and attributing the causes of pneumonia are suboptimal.

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“…5 There are approximately 2.9 deaths per 100,000 population per year in infants infected with RSV and a respiratory cause of death under 12 months in the UK 6 and around 5.3 deaths per 100,000 in the USA. 7 Around 40-50% of infants requiring hospital admission with Paediatric Respiratory Reviews 11 (2010) [39][40][41][42][43][44][45]…”

Section: Introductionmentioning

confidence: 99%

Acute viral bronchiolitis in children- a very common condition with few therapeutic options

Wainwright

2010

Paediatric Respiratory Reviews

113

129

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Acute viral bronchiolitis remains a cause of substantial morbidity and health care costs in young infants. It is the most common lower respiratory tract condition and most common reason for admission to hospital in infants. Many respiratory viruses have been associated with acute viral bronchiolitis although respiratory syncytial virus (RSV) remains the most frequently identified virus. Most infants have a mild self limiting illness while others have more severe illness and require hospital admission and some will need ventilatory support. Differences in innate immune function in response to the respiratory viral insult as well as differences in the geometry of the airways may explain some of the variability in clinical pattern. Young age and history of prematurity remain the most important risk factors although male gender, indigenous status, exposure to tobacco smoke, poor socioeconomic factors and associated co-morbidities such as chronic lung disease and congenital heart disease increase the risks of more severe illness. Supportive therapy remains the major treatment option as no specific treatments to date have been shown to provide clinically important benefits except for inhaled hypertonic saline. Prophylaxis of high risk infants with palivizumab should be considered although the cost effectiveness is still unclear. Many questions remain regarding optimal management approaches for infants requiring hospitalisation with bronchiolitis including use of nasogastric feeding, the optimal role of supplemental oxygen, optimal use of hypertonic saline and the role of combinations of therapies, the use of heliox or modern physiotherapy approaches.

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A Randomized, Controlled Trial of the Impact of Early and Rapid Diagnosis of Viral Infections in Children Brought to an Emergency Department with Febrile Respiratory Tract Illnesses

Cited by 61 publications

References 17 publications

Systematic review of the impact of point‐of‐care testing for influenza on the outcomes of patients with acute respiratory tract infection

Systematic review of the impact of point‐of‐care testing for influenza on the outcomes of patients with acute respiratory tract infection

Advances in the diagnosis of pneumonia in children

Acute viral bronchiolitis in children- a very common condition with few therapeutic options

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