[Impact of the rapid diagnosis downtown in the assumption of responsibility of the children in period of influenza]

Abstract

Several studies in children showed at the paediatric emergency hospital the interest of influenza rapid diagnostic tests (IRDT) in this disease for which the clinical diagnosis is difficult in children. The purpose of this prospective study carried out in ambulatory paediatric setting was to evaluate impact of the IRDT in the assumption of responsibility of children suspected of Influenza infection. Thirty paediatricians (14 without IRDT, 16 with IRDT) included 602 children between 2004 and 2005. The influenza was confirmed by IRDT in 54% of the cases. Among the 13 symptoms or signs recorded, only 4 - chills (61.6 vs 48.4%), cough (89.8 vs 71.1%), rhinorrhea (97.9 vs 86.2%), and anorexia (50.3 vs 34.8%) - were significantly more frequent (P </= 0.01) for patients avec with positive IRDT. However, the difference is not sufficient to be contributive. The paediatricians using IRDT prescribed with positive test more oseltamivir (68.5 vs 1.9%, P < 0.0001). The antibiotic prescription was overall low (9.5% with IRDT vs 3.9% without IRDT, P = 0,008), and primarily when the result of IRDT was negative (15.7% if IRDT(-) vs 4.3% if IRDT(+), P = 0.0003). This study confirms the difficulty of clinical diagnosis, and shows the interest of IRDT for the diagnosis of influenza and consequently to improve the management of influenza in children in ambulatory paediatric setting.