Clinical Outcomes of Rapid Respiratory Virus Testing in Emergency Departments

Abstract

ImportanceRapid tests for respiratory viruses, including multiplex panels, are increasingly available in emergency departments (EDs). Their association with patient outcomes remains unclear.ObjectiveTo determine if ED rapid respiratory virus testing in patients with suspected acute respiratory infection (ARI) was associated with decreased antibiotic use, ancillary tests, ED length of stay, and ED return visits and hospitalization and increased influenza antiviral treatment.Data SourcesOvid MEDLINE, Embase (Ovid), Scopus, and Web of Science from 1985 to November 14, 2022.Study SelectionRandomized clinical trials of patients of any age with ARI in an ED. The primary intervention was rapid viral testing.Data Extraction and SynthesisPreferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines were followed. Two independent reviewers (T.S. and K.W.) extracted data and assessed risk of bias using the Cochrane Risk of Bias, version 2.0. Estimates were pooled using random-effects models. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations framework.Main Outcomes and MeasuresAntibiotic use and secondary outcomes were pooled separately as risk ratios (RRs) and risk difference estimates with 95% CIs.ResultsOf 7157 studies identified, 11 (0.2%; n = 6068 patients) were included in pooled analyses. Routine rapid viral testing was not associated with antibiotic use (RR, 0.99; 95% CI, 0.93-1.05; high certainty) but was associated with higher use of influenza antivirals (RR, 1.33; 95% CI, 1.02-1.75; moderate certainty) and lower use of chest radiography (RR, 0.88; 95% CI, 0.79-0.98; moderate certainty) and blood tests (RR, 0.81; 95% CI, 0.69-0.97; moderate certainty). There was no association with urine testing (RR, 0.95; 95% CI, 0.77-1.17; low certainty), ED length of stay (0 hours; 95% CI, −0.17 to 0.16; moderate certainty), return visits (RR, 0.93; 95%, CI 0.79-1.08; moderate certainty) or hospitalization (RR, 1.01; 95% CI, 0.95-1.08; high certainty). Adults represented 963 participants (16%). There was no association of viral testing with antibiotic use in any prespecified subgroup by age, test method, publication date, number of viral targets, risk of bias, or industry funding.Conclusions and RelevanceThe results of this systematic review and meta-analysis suggest that there are limited benefits of routine viral testing in EDs for patients with ARI. Further studies in adults, especially those with high-risk conditions, are warranted.

Enhancing the Methods of a Rapid Virus Testing Study

“…To the Editor We read with great interest the study conducted by Schober et al, in which the objective was to assess whether rapid respiratory virus testing in emergency department patients suspected of having acute respiratory infections correlates with reduced antibiotic administration, fewer ancillary tests, shorter emergency department duration, and lower rates of emergency department revisits and hospital admissions, alongside an increase in influenza antiviral therapy. I would like to start by commending the author for adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline and registering the protocol in the International Prospective Register of Systematic Reviews (PROSPERO), which established a strong foundation for this systematic review . However, when analyzing the research methods, I identified several areas that could further strengthen the study.…”

“…First, the initial study noted that selection was conducted by a single reviewer . Although this practice is not uncommon, engaging 2 independent reviewers from the outset could minimize selection bias, ensuring a more comprehensive and unbiased coverage of the relevant literature …”

“…The handling of heterogeneity also warrants attention. Although a random-effects model was used, delving deeper into the interpretation of this heterogeneity, considering the clinical and methodological differences among the studies, would enrich the analysis. The inclusion of quasi-randomized studies raises concerns about potential bias.…”

“…Lastly, the assessment of publication bias was limited to groups with a substantial number of studies . Addressing publication bias in analyses with fewer studies could provide a more comprehensive and balanced perspective .…”

Enhancing the Methods of a Rapid Virus Testing Study—Reply

“…In Reply We express our gratitude to Acuña-Rocha for raising 4 important points regarding the methods of our systematic review and meta-analysis of randomized clinical trials on the impact of rapid respiratory virus testing in emergency departments on clinical outcomes …”