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. 2014 Jun;3(2):112-8.
doi: 10.1093/jpids/pit071. Epub 2013 Nov 13.

A National Study of the Impact of Rapid Influenza Testing on Clinical Care in the Emergency Department

Anne J Blaschke  1 , Daniel J Shapiro  2 , Andrew T Pavia  1 , Carrie L Byington  1 , Krow Ampofo  1 , Chris Stockmann  3 , Adam L Hersh  1
Affiliations

A National Study of the Impact of Rapid Influenza Testing on Clinical Care in the Emergency Department

Anne J Blaschke et al. J Pediatric Infect Dis Soc. 2014 Jun.

Abstract

Background: Rapid influenza diagnostic tests (RIDT) may influence physician decision-making. Single-center studies suggest that influenza diagnosed in association with RIDT reduces ancillary testing and antibiotic prescribing. The extent of RIDT use in US emergency departments (EDs) and their impact on patient management are unknown. We examined the use of RIDT and its effect on influenza management, using a national sample of ED visits.

Methods: We performed a retrospective study using data from the National Hospital Ambulatory Medical Care Survey, an annually administered survey capturing a nationally representative sample of visits to US EDs. We identified patient visits in which RIDT was performed and/or influenza was diagnosed across 3 influenza seasons (2007-2009). Ancillary testing and antibiotic and antiviral prescribing were evaluated for 2 groups of patients in whom RIDT was performed (those given or not given a diagnosis of influenza) and a third group in whom influenza was diagnosed but RIDT was not performed.

Results: Rapid influenza diagnostic tests were performed during 4.2 million visits. Forty-two percent of influenza diagnoses were made in association with RIDT. For patients diagnosed with influenza, ancillary test ordering was lower (45% vs 53% of visits) and there were fewer antibiotic prescriptions (11% vs 23%), and antiviral use was higher (56% vs 19%) when the diagnosis was made in association with RIDT.

Conclusions: Influenza diagnoses made in association with RIDT resulted in fewer tests and antibiotic prescriptions and more frequent use of antivirals. This finding suggests that test results influence physician behavior.

Keywords: emergency department; influenza; influenza testing; rapid diagnostics; rapid influenza testing.

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Figures

Figure 1.
Figure 1.
Graphic illustrates the study period. National Hospital Ambulatory Medical Care Survey (NHAMCS) started recording rapid influenza diagnostic tests (RIDT) use in January 2007. Our study period encompassed 3 influenza seasons (shaded in dark gray), including the months of January–April 2007–2009 and October–December 2007 and 2008. The months of May–September were excluded each year. Our study period ended at the onset of the 2009 H1N1 pandemic.
Figure 2.
Figure 2.
The graphic depicts the study population. From all emergency department visits during the study period, we identified visits with and without rapid influenza diagnostic tests (RIDT) performed. Visits with RIDT performed were divided into those with and without an influenza diagnosis. From visits without RIDT performed, those with an influenza diagnosis were identified and included in the study cohort. Visits with neither RIDT nor an influenza diagnosis were excluded. Abbreviations: CI, confidence interval; EV, estimated visits; SV, sampled visits.
See this image and copyright information in PMC

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