The Influence of Rapid Influenza Diagnostic Testing on Clinician Decision-Making for Patients With Acute Respiratory Infection in Urgent Care

被引：9

作者：

Stamm, Brian D. ^{[1
,2
,4
]}

Tamerius, John ^{[3
]}

Reddy, Sush ^{[3
]}

Barlow, Shari ^{[2
]}

Hamer, Caroline ^{[2
]}

Kempken, Ashley ^{[2
]}

Goss, Maureen ^{[2
]}

He, Cecilia ^{[2
]}

Bell, Cristalyne ^{[2
]}

Arnold, Mitchell ^{[2
]}

Checovich, Mary ^{[2
]}

Temte, Emily ^{[2
]}

Norton, Derek ^{[2
]}

Chen, Guanhua ^{[2
]}

Baltus, Jeffrey ^{[2
]}

Gurley, Emily S. ^{[1
]}

Temte, Jonathan L. ^{[2
]}

机构：

[1] Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Baltimore, MD USA

[2] Univ Wisconsin Madison, Sch Med & Publ Hlth, Madison, WI USA

[3] Quidel Corp, San Diego, CA USA

[4] Univ Wisconsin, Dept Family Med & Community Hlth, Sch Med & Publ Hlth, 1100 Delaplaine Court, Madison, WI 53715 USA

来源：

CLINICAL INFECTIOUS DISEASES | 2023年 / 76卷 / 11期

关键词：

rapid influenza diagnostic test; antiviral and antibiotic prescribing; acute respiratory infection; influenza; antibiotic resistance; FEBRILE INFANTS; MANAGEMENT; EMERGENCY; ILLNESS; RECEIPT; IMPACT;

D O I：

10.1093/cid/ciad038

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Use of rapid influenza diagnostic tests in patients who present to urgent care with acute respiratory infection symptoms influences clinician diagnostic and treatment decision-making, which could lead to improved patient outcomes, population-level reductions in influenza burden, and a decreased threat of antibiotic resistance. Background The potential benefits of using rapid influenza diagnostic tests (RIDTs) in urgent care facilities for clinical care and prescribing practices are understudied. We compared antiviral and antibiotic prescribing, imaging, and laboratory ordering in clinical encounters with and without RIDT results. Methods We compared patients with acute respiratory infection (ARI) symptoms who received an RIDT and patients who did not at 2 urgent care facilities. Primary analysis using 1-to-1 exact matching resulted in 1145 matched pairs to which McNemar 2 x 2 tests were used to assess the association between the likelihood of prescribing, imaging/laboratory ordering, and RIDT use. Secondary analysis compared the same outcomes using logistic regression among the RIDT-tested population between participants who tested negative (RIDT(-)) and positive (RIDT(+)). Results Primary analysis revealed that compared to the non-RIDT-tested population, RIDT(+) patients were more likely to be prescribed antivirals (OR, 10.23; 95% CI, 5.78-19.72) and less likely to be prescribed antibiotics (OR, 0.15; 95% CI, .08-.27). Comparing RIDT-tested to non-RIDT-tested participants, RIDT use increased antiviral prescribing odds (OR, 3.07; 95% CI, 2.25-4.26) and reduced antibiotic prescribing odds (OR, 0.52; 95% CI, .43-.63). Secondary analysis identified increased odds of prescribing antivirals (OR, 28.21; 95% CI, 18.15-43.86) and decreased odds of prescribing antibiotics (OR, 0.20; 95% CI, .13-.30) for RIDT(+) participants compared with RIDT(-). Conclusions Use of RIDTs in patients presenting with ARI symptoms influences clinician diagnostic and treatment decision-making, which could lead to improved patient outcomes, population-level reductions in influenza burden, and a decreased threat of antibiotic resistance.

引用

页码：1942 / 1948

页数：7