Diagnostic Stewardship—The Impact of Rapid Diagnostic Testing for Paediatric Respiratory Presentations in the Emergency Setting: A Systematic Review

Weragama, Keshani; Mudgil, Poonam; Whitehall, John

doi:10.3390/children9081226

Cited by 8 publications

(9 citation statements)

References 39 publications

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“…When comparing the rate of oseltamivir prescription for RMDTs versus standard tests, although the estimated odds ratio of 0.70 showed a reduction, the results were not statistically significant [ 43 ]. Weragama et al, 2022 [ 24 ] assessed, via an SLR, the clinical impact of rapid antigen and molecular diagnostic testing in children with respiratory symptoms presenting to ED. Although a formal MA was not conducted in the study, findings showed some evidence that antibiotic prescription and ancillary testing were reduced using RMDTs compared to other approaches, such as standard molecular test and immunofluorescence assay [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Weragama et al, 2022 [ 24 ] assessed, via an SLR, the clinical impact of rapid antigen and molecular diagnostic testing in children with respiratory symptoms presenting to ED. Although a formal MA was not conducted in the study, findings showed some evidence that antibiotic prescription and ancillary testing were reduced using RMDTs compared to other approaches, such as standard molecular test and immunofluorescence assay [ 24 ]. Lastly, Vos et al, 2019 [ 39 ] provided a qualitative summary of studies assessing the clinical impact of RMDTs for respiratory infections, which showed that turnaround times were significantly shorter with RMDTs compared with standard molecular tests.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, two pre-COVID-19 SLRs/MAs of studies among patients of all ages drew mixed conclusions regarding the impact of RMDTs and antigen diagnostic tests on the prescription of antibiotics and antivirals and length of stay (LoS) at the emergency department (ED) [ 39 , 42 ]. However, two post-COVID SLR/MAs of studies among pediatric patients concluded that RMDTs reduced antibiotic prescriptions and increased antiviral prescriptions, with some evidence suggesting that these tests also reduced LoS at the hospital and duration of therapy [ 24 , 43 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical impact of rapid molecular diagnostic tests in patients presenting with viral respiratory symptoms: A systematic literature review

Mojebi,

Wu,

Keeping

et al. 2024

PLoS ONE

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Background Molecular tests can detect lower concentrations of viral genetic material over a longer period of respiratory infection than antigen tests. Delays associated with central laboratory testing can result in hospital-acquired transmission, avoidable patient admission, and unnecessary use of antimicrobials, all which may lead to increased cost of patient management. The aim of this study was to summarize comparisons of clinical outcomes associated with rapid molecular diagnostic tests (RMDTs) versus other diagnostic tests for viral respiratory infections. Methods A systematic literature review (SLR) conducted in April 2023 identified studies evaluating clinical outcomes of molecular and antigen diagnostic tests for patients suspected of having respiratory viral infections. Results The SLR included 21 studies, of which seven and 14 compared RMDTs (conducted at points of care or at laboratories) to standard (non-rapid) molecular tests or antigen tests to detect SARS-CoV-2 and influenza, respectively. In studies testing for SARS-CoV-2, RMDTs led to reductions in time to test results versus standard molecular tests (range of the reported medians: 0.2–3.8 hours versus 4.3–35.9 hours), with similar length of emergency department stay (3.2–8 hours versus 3.7–28.8 hours). Similarly, in studies testing for influenza, RMDTs led to reductions in time to test results versus standard molecular tests (1–3.5 hours versus 18.2–29.2 hours), with similar length of emergency department stay (3.7–11 hours versus 3.8–11.9 hours). RMDTs were found to decrease exposure time of uninfected patients, rate of hospitalization, length of stay at the hospitals, and frequency of unnecessary antiviral and antibacterial therapy, while improving patient flow, compared to other tests. Conclusions Compared to other diagnostic tests, RMDTs improve clinical outcomes, test turnaround time, and stewardship by decreasing unnecessary use of antibiotics and antivirals. They also reduce hospital admission and length of stay, which may, in turn, reduce unnecessary exposure of patients to hospital-acquired infections and their associated costs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical impact of rapid molecular diagnostic tests in patients presenting with viral respiratory symptoms: A systematic literature review

Mojebi,

Wu,

Keeping

et al. 2024

PLoS ONE

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“…For example, rapid diagnostic testing for respiratory infections in the emergency setting has been shown to prevent unnecessary antibiotic prescriptions. [32] It is, therefore, prudent to examine all test use to identify potential areas where testing may confer benefit as well as areas where testing causes harms.…”

Section: Rank Order Of Practice Variability Of Specific Testsmentioning

confidence: 99%

Temporal trends and practice variation of paediatric diagnostic tests in primary care

Thomas,

Withrow,

Gill

et al. 2024

Preprint

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Objective: The primary objective was to investigate temporal trends and between-practice variability of paediatric test use in primary care. Methods and analysis: This was a descriptive study of population-based data from primary care consultation records from January 1, 2007, to December 31, 2019. Children aged 0 to 15 who were registered to one of the 1,464 practices and had a diagnostic test code in their clinical record were included. The primary outcome measures were: 1) temporal changes in test rates measured by the average annual percent change (AAPC), stratified by test type, gender, age group, and deprivation level and 2) practice variability in test use, measured by the coefficient of variation (CoV). Results: 14,299,598 diagnostic tests were requested over 27.8 million child-years of observation for 2,542,101 children. Overall test use increased by 3.6%/year (95% CI 3.4 to 3.8%) from 399/1,000-child-years to 608/1,000 child-years, driven by increases in blood tests (8.0%/year, 95% CI 7.7 to 8.4), females aged 11-15 (4.0%/year, 95% CI 3.7 to 4.3), and the most socioeconomically deprived group (4.4%/year, 95% CI 4.1 to 4.8). Tests subject to the greatest temporal increases were fecal calprotectin, fractional exhaled nitric oxide (FeNO), and vitamin D. Tests classified as high use and high practice variability were iron studies, vitamin D, vitamin B12, folate, and coeliac testing. Conclusions: In this first nationwide study of paediatric test use in primary care, we observed significant temporal increases and practice variability in testing. This reflects inconsistency in practice and diagnosis rates, and a scarcity of evidence-based guidance. Increased test use generates more clinical activity with significant resource implications, but conversely may improve clinical outcomes. Future research should evaluate whether increased test use and variability is warranted by exploring test indications and test results, and directly examine how increased test use impacts on quality of care.

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“…Editorials and reviews have attempted to define the term [9,[15][16][17], and some have detailed the various stages where interventions may be applied in the pre-analytical, analytical and post-analytical phases [9]. However, publications, including systematic reviews [18], retrospective studies [19,20] and multi-centre validation of machine learning tools [21], have used the term without defining it. One collaborative study regarding paediatric blood cultures (BCs) defined diagnostic stewardship as "optimising the use of diagnostic tests to improve treatment decisions" [22].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic stewardship in infectious diseases: a scoping review

Shorten,

Pickering,

Goolden

et al. 2024

Journal of Medical Microbiology

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Introduction. The term ‘diagnostic stewardship’ is relatively new, with a recent surge in its use within the literature. Despite its increasing popularity, a precise definition remains elusive. Various attempts have been made to define it, with some viewing it as an integral part of antimicrobial stewardship. The World Health Organization offers a broad definition, emphasizing the importance of timely, accurate diagnostics. However, inconsistencies in the use of this term still persist, necessitating further clarification. Gap Statement. There are currently inconsistencies in the definition of diagnostic stewardship used within the academic literature. Aim. This scoping review aims to categorize the use of diagnostic stewardship approaches and define this approach by identifying common characteristics and factors of its use within the literature. Methodology. This scoping review undertook a multi-database search from date of inception until October 2022. Any observational or experimental study where the authors define the intervention to be diagnostic stewardship from any clinical area was included. Screening of all papers was undertaken by a single reviewer with 10% verification by a second reviewer. Data extraction was undertaken by a single reviewer using a pre-piloted form. Given the wide variation in study design and intervention outcomes, a narrative synthesis approach was applied. Studies were clustered around common diagnostic stewardship interventions where appropriate. Results. After duplicate removal, a total of 1310 citations were identified, of which, after full-paper screening, 105 studies were included in this scoping review. The classification of an intervention as taking a diagnostic stewardship approach is a relatively recent development, with the first publication in this field dating back to 2017. The majority of research in this area has been conducted within the USA, with very few studies undertaken outside this region. Visual inspection of the citation map reveals that the current evidence base is interconnected, with frequent references to each other’s work. The interventions commonly adopt a restrictive approach, utilizing hard and soft stops within the pre-analytical phase to restrict access to testing. Upon closer examination of the outcomes, it becomes evident that there is a predominant focus on reducing the number of tests rather than enhancing the current test protocol. This is further reflected in the limited number of studies that report on test performance (including protocol improvements, specificity and sensitivity). Conclusion. Diagnostic stewardship seems to have deviated from its intended course, morphing into a rather rudimentary instrument wielded not to enhance but to constrict the scope of testing. Despite the World Health Organization’s advocacy for an ideology that promotes a more comprehensive approach to quality improvement, it may be more appropriate to consider alternative regional narratives when categorizing these types of quality improvement interventions.

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Diagnostic Stewardship—The Impact of Rapid Diagnostic Testing for Paediatric Respiratory Presentations in the Emergency Setting: A Systematic Review

Cited by 8 publications

References 39 publications

Clinical impact of rapid molecular diagnostic tests in patients presenting with viral respiratory symptoms: A systematic literature review

Clinical impact of rapid molecular diagnostic tests in patients presenting with viral respiratory symptoms: A systematic literature review

Temporal trends and practice variation of paediatric diagnostic tests in primary care

Diagnostic stewardship in infectious diseases: a scoping review

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