Using a novel rapid viral test to improve triage of emergency department patients with acute respiratory illness during flu season

Pedersen, Courtney J.; Rogan, Daniel T.; Yang, Samuel; Quinn, James V.

doi:10.1016/j.jcv.2018.09.008

Cited by 15 publications

(18 citation statements)

References 39 publications

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“…27,28 For influenza virus, and in some cases RSV, studies utilizing point-of-care (POC) diagnostic tests for these specific organisms have shown value in terms of patient management, patient cohorting and droplet precautions, and appropriate anti-viral therapy. [29][30][31] However, for large, molecular multiplex methods, it is unclear whether or not they should be employed broadly for general surveillance purposes, or restricted to specific populations, i.e., pediatric patients, high risk ED patients, and the immunocompromised. 27 Coinfections are more readily detected on molecular panels, however, clinical consequences of coinfections are not totally clear.…”

Section: Resultsmentioning

confidence: 99%

Identification of Pathogens from the Upper Respiratory Tract of Adult Emergency Department Patients at High Risk for Influenza Complications

Hardick

Saliba

McBryde

et al. 2020

Preprint

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Acute upper respiratory infections (URIs) represent a major source of annual emergency department (EDs) visits in the United States. However, the definitive etiology of symptoms is generally not determined as testing has historically been prioritized for influenza virus and recently, respiratory syncytial virus (RSV). To elucidate the prevalence, rates of co-infections, and etiologic composition of URIs from symptomatic adult ED patients, we evaluated specimens from four geographically diverse EDs in the United States from 2013-2014 utilizing a multiplex molecular diagnostic assay. 1941 ED patients who had signs and/or symptoms of an acute URI and were considered 'high-risk' for influenza related complications according to CDC criteria, were consecutively enrolled and tested for influenza; influenza prevalence was 9.4% (183/1941). Among them, 799 nasopharyngeal swab specimens with sufficient residual volumes were subsequently tested for additional respiratory pathogens. The overall positivity rate was 30.1% (241/799), of which 6.6% (16/241) were co-infected. Non-influenza pathogens from most to least common were: rhinovirus/enterovirus, coronavirus, human metapneumovirus and RSV, respectively. The ratio of co-infection to mono-infection was highest amongst those with adenovirus, versus mon-infections (2.0). Broad differences in disease prevalence and pathogen distributions were observed across geographic regions; the site with the highest detection rate (for both mono and co-infections) demonstrated the greatest pathogen diversity. Adult ED patients at high-risk for influenza complications were infected with a variety of respiratory pathogens and geographic variations in the disease prevalence and co-pathogen type were observed. Further research is required to evaluate the clinical relevance of these findings.

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Section: Resultsmentioning

confidence: 99%

Identification of Pathogens from the Upper Respiratory Tract of Adult Emergency Department Patients at High Risk for Influenza Complications

Hardick

Saliba

McBryde

et al. 2020

Preprint

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“…The study that reported the lower sensitivity might have been subject to bias because only negative results were systematically centrally controlled, thus increasing the likelihood of false positives. Only one study investigated the performance of RT-PCR assay at triage [11] and found a sensitivity and specificity of respectively 1.00 and 0.95. However, this result is based on only 38 specimens obtained during a normal working day.…”

Section: Discussionmentioning

confidence: 99%

“…[8,10] Evaluation of the patient’s viral-status is important to determine if the patient requires isolation or not, and thus to ensure the smooth running of the emergency department and hospitalization units. [11]…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of a rapid RT-PCR assay for point-of-care detection of influenza A/B virus at emergency department admission: A prospective evaluation during the 2017/2018 influenza season

et al. 2019

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Study objective To investigate the performance of a rapid RT-PCR assay to detect influenza A/B at emergency department admission. Methods This single-center prospective study recruited adult patients attending the emergency department for influenza-like illness. Triage nurses performed nasopharyngeal swab samples and ran rapid RT-PCR assays using a dedicated device (cobas Liat, Roche Diagnostics, Meylan, France) located at triage. The same swab sample was also analyzed in the department of virology using conventional RT-PCR techniques. Patients were included 24 hours-a-day, 7 days-a-week. The primary outcome was the diagnostic accuracy of the rapid RT-PCR assay performed at triage. Results A total of 187 patients were included over 11 days in January 2018. Median age was 70 years (interquartile range 44 to 84) and 95 (51%) were male. Nine (5%) assays had to be repeated due to failure of the first assay. The sensitivity of the rapid RT-PCR assay performed at triage was 0.98 (95% confidence interval (CI): 0.91–1.00) and the specificity was 0.99 (95% CI: 0.94–1.00). A total of 92 (49%) assays were performed at night-time or during the weekend. The median time from patient entry to rapid RT-PCR assay results was 46 [interquartile range 36–55] minutes. Conclusion Rapid RT-PCR assay performed by nurses at triage to detect influenza A/B is feasible and highly accurate.

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“…For example, antiviral drugs may be started more quickly and appropriately and unnecessary antibiotics stopped earlier [ 4–8 ]. Additionally, rapid diagnosis may offer the potential to decrease transmission to other patients and staff by rapid instigation of relevant infection prevention and control precautions [ 7, 9, 10 ], and may assist clinicians to make decisions earlier regarding discharge of infected patients, potentially reducing their length of stay in hospital and easing pressure on hospital beds [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Point of care testing of Influenza A/B and RSV in an adult respiratory assessment unit is associated with improvement in isolation practices and reduction in hospital length of stay

Berry

Lansbury

Gale

et al. 2020

Journal of Medical Microbiology

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Introduction. Every winter seasonal influenza and other viral respiratory infections increase pressure on the health services and are associated with nosocomial infection and morbidity. Aim. To compare provision of point-of-care (POC) testing with laboratory-based testing for influenza and RSV detection on an adult respiratory assessment unit to assess the impact on isolation practices and length of stay (LOS). Methodology. Prospective interrupted ‘on-off’ study in adults admitted to the respiratory unit between December 2018 and April 2019 with a suspected respiratory tract infection. Nasopharyngeal samples were tested using either the GeneXpert rapid POC test for influenza and RSV (on-period), or were sent to the laboratory for multiplex PCR testing against a panel of 12 respiratory viruses (off-period). Outcome measures were time to patient isolation for infection control, LOS and turnaround time from admission to test results. Results. Of 1145 patients evaluated, 755 were tested with POC and 390 with laboratory multiplex; a respiratory virus was identified in 164 (21.7 %) and 138 (35.4 %) patients respectively. A positive POC test was associated with a shorter time to isolation (mean difference 16.9 h, P <0.001), shorter LOS (mean difference 15.5 h, P =0.05,) and shorter turnaround time (mean difference 28.3 h, P <0.001), compared to laboratory testing. Conclusion. Use of GeneXpert POC testing for Flu/RSV is associated with rapid reporting of results with significant improvements in isolation practices and reductions in LOS.

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Using a novel rapid viral test to improve triage of emergency department patients with acute respiratory illness during flu season

Abstract: Rapid POC-PCR for influenza and RSV in ED triage has excellent sensitivity and specificity and the potential to improve social distancing practices through better triage and increase appropriate prescription of antimicrobials.

Cited by 15 publications

References 39 publications

Identification of Pathogens from the Upper Respiratory Tract of Adult Emergency Department Patients at High Risk for Influenza Complications

Identification of Pathogens from the Upper Respiratory Tract of Adult Emergency Department Patients at High Risk for Influenza Complications

Diagnostic accuracy of a rapid RT-PCR assay for point-of-care detection of influenza A/B virus at emergency department admission: A prospective evaluation during the 2017/2018 influenza season

Point of care testing of Influenza A/B and RSV in an adult respiratory assessment unit is associated with improvement in isolation practices and reduction in hospital length of stay

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