Iyer Srikant B, Gerber Michael A, Pomerantz Wendy J, Mortensen Joel E, Ruddy Richard M
Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Acad Emerg Med. 2006 Dec;13(12):1259-68. doi: 10.1197/j.aem.2006.07.026. Epub 2006 Nov 1.
To determine the effect of point-of-care testing (POCT) for influenza on the physician management of febrile children who are at risk for serious bacterial illness (SBI) on the basis of age and temperature and who are presenting to a pediatric emergency department (ED) during an influenza outbreak.
Patients 2-3 months of age with temperature of > or = 38 degrees C and patients 3-24 months of age with temperature of > or = 39 degrees C who were presenting to a pediatric ED during an influenza outbreak were enrolled into a prospective, quasi-randomized, controlled trial. Influenza testing was performed on enrolled patients by either the POCT or the standard-testing (ST) methods. The two groups were compared in terms of laboratory testing, chest radiography, antibiotic use, visit-associated costs, pediatric ED lengths of stay, inpatient admission, and return visits to the pediatric ED. Similar analyses also were performed on the resulting subgroups of patients on the basis of method of testing (POCT or ST) and test result (positive or negative).
Of 767 eligible patients, 700 (91%) completed the study. No significant differences were demonstrated between the POCT and ST groups with respect to laboratory tests ordered, chest radiographs obtained, antibiotic administration, inpatient admission, return visits to the pediatric ED, lengths of stay, or visit-associated costs. In the subgroup analysis, the adjusted odds ratios (ORs) for blood culture in influenza test-positive to -negative patients were 0.59 and 0.71 in the POCT and ST groups, respectively (p = 0.088). The adjusted ORs for urine culture in influenza test-positive to -negative patients were 0.46 and 0.67 in the POCT and ST groups, respectively (p = 0.005).
When using a strategy of performing influenza testing on all patients at risk for SBI who presented to a pediatric ED during an influenza outbreak, the method of testing (POCT or ST) did not appear to significantly alter physician management, cost, or length of stay in the pediatric ED. However, if the interaction of the method of testing and the test result (positive or negative) were considered, a positive POCT for influenza was associated with a significant reduction in orders for urinalyses and urine cultures.
确定在流感暴发期间，针对有严重细菌感染（SBI）风险的发热儿童（根据年龄和体温判断），在儿科急诊科（ED）进行流感即时检验（POCT）对医生诊疗管理的影响。
将流感暴发期间到儿科急诊科就诊的2至3个月龄体温≥38摄氏度以及3至24个月龄体温≥39摄氏度的患者纳入一项前瞻性、半随机对照试验。采用POCT或标准检验（ST）方法对入组患者进行流感检测。比较两组在实验室检查、胸部X光检查、抗生素使用、就诊相关费用、儿科急诊科留观时间、住院情况以及返回儿科急诊科复诊等方面的差异。还根据检测方法（POCT或ST）和检测结果（阳性或阴性）对所得患者亚组进行了类似分析。
767名符合条件患者中，700名（91%）完成了研究。在开具的实验室检查、进行的胸部X光检查、抗生素使用、住院情况、返回儿科急诊科复诊、留观时间或就诊相关费用方面，POCT组和ST组之间未显示出显著差异。在亚组分析中，POCT组和ST组流感检测阳性与阴性患者血培养的校正比值比（OR）分别为0.59和0.71（p = 0.088）。POCT组和ST组流感检测阳性与阴性患者尿培养的校正OR分别为0.46和0.67（p = 0.005）。
在流感暴发期间，对到儿科急诊科就诊的所有有SBI风险的患者采用流感检测策略时，检测方法（POCT或ST）似乎并未显著改变医生的诊疗管理、费用或儿科急诊科的留观时间。然而，如果考虑检测方法与检测结果（阳性或阴性）的相互作用，流感POCT检测呈阳性与尿液分析和尿培养医嘱的显著减少相关。
