Doan Quynh, Enarson Paul, Kissoon Niranjan, Klassen Terry P, Johnson David W
Emergency Department, British Columbia Children's Hospital, 4500 Oak Street, Vancouver, British Columbia, Canada, V6H 3N1.
Cochrane Database Syst Rev. 2009 Oct 7(4):CD006452. doi: 10.1002/14651858.CD006452.pub2.
Pediatric acute respiratory infections (ARIs) represent a significant burden on pediatric emergency departments (ED) and families. Most of these illnesses are due to viruses. However, investigations (radiography, blood and urine testing) to rule out bacterial infections and antibiotics are often ordered because of diagnostic uncertainties. This results in prolonged ED visits and unnecessary antibiotic use. The risk of concurrent bacterial infection has been reported to be negligible in children over three months of age with a confirmed viral infection. Rapid viral testing in the ED may alleviate the need for precautionary testing and antibiotic use.
To determine the effect of rapid viral testing in the ED on the rate of precautionary testing, antibiotic use and ED length of visit.
We searched the Cochrane Central register of Controlled Trials (CENTRAL) (The Cochrane Library, 2009, issue 1) which contains the ARI Group's Specialized Register, MEDLINE (1950 to April Week 3 2009), EMBASE (1988 to Week 16, 2009), MEDLINE In-Process & Other Non-Indexed Citations (April 27, 2009), HealthStar (1966 to 2009), BIOSIS Previews (1969 to 2009), CAB Abstracts (1973 to 2007), CBCA Reference (1970 to 2007), and Proquest Dissertations and Theses (1861 to 2009).
Randomized controlled trials (RCTs) of rapid viral testing for children with ARIs in the ED.
Two review authors used the inclusion criteria to select trials, evaluate their quality and extract data. Missing data were obtained from trial authors. Differences in rate of investigations and antibiotics use were expressed as risk ratios (RR) and difference in ED length of visits was expressed as mean difference, with 95% confidence interval (CI).
Four trials were included, three RCTs and one quazi-RCT, with 759 children in the rapid viral testing and 829 in the control group. Rapid viral testing did not reduce antibiotic use in the ED significantly, neither clinically nor statistically. We found lower rates of chest radiography (RR 0.77, 95% CI 0.65 to 0.91) in the rapid viral testing group but no effect on length of ED visits, blood or urine testing in the ED.
AUTHORS' CONCLUSIONS: Current evidence is insufficient, although promising, to support routine rapid viral testing as a means to reduce antibiotic use in pediatric EDs. Results suggest that rapid viral testing may be beneficial but are not statistically significant due to lack of power. A large trial addressing these outcome measures is needed.
小儿急性呼吸道感染（ARIs）给儿科急诊科（ED）和家庭带来了沉重负担。这些疾病大多由病毒引起。然而，由于诊断存在不确定性，通常会进行相关检查（如X光、血液和尿液检测）以排除细菌感染，并开具抗生素。这导致患儿在急诊科的就诊时间延长，且出现不必要的抗生素使用情况。据报道，对于确诊为病毒感染的3个月以上儿童，并发细菌感染的风险可忽略不计。在急诊科进行快速病毒检测可能会减少预防性检测和抗生素的使用。
确定在急诊科进行快速病毒检测对预防性检测率、抗生素使用及急诊科就诊时长的影响。
我们检索了Cochrane对照试验中心注册库（CENTRAL）（《Cochrane图书馆》，2009年第1期），其中包含ARI小组的专业注册库、MEDLINE（1950年至2009年第4周第3期）、EMBASE（1988年至2009年第16周）、MEDLINE在研及其他未索引文献（2009年4月27日）、HealthStar（1966年至2009年）、BIOSIS预评（1969年至2009年）、CAB文摘（1973年至2007年）、CBCA参考文献（1970年至2007年）以及Proquest学位论文（1861年至2009年）。
针对急诊科患有ARIs儿童的快速病毒检测的随机对照试验（RCTs）。
两位综述作者使用入选标准选择试验、评估其质量并提取数据。缺失数据从试验作者处获取。检查率和抗生素使用率的差异以风险比（RR）表示，急诊科就诊时长的差异以平均差表示，并给出95%置信区间（CI）。
纳入了四项试验，三项RCT和一项半随机对照试验，快速病毒检测组有759名儿童，对照组有829名儿童。快速病毒检测在临床上和统计学上均未显著降低急诊科的抗生素使用。我们发现快速病毒检测组的胸部X光检查率较低（RR 0.77，95% CI 0.65至0.91），但对急诊科就诊时长、血液或尿液检测无影响。
尽管目前的证据有一定前景，但不足以支持将常规快速病毒检测作为减少儿科急诊科抗生素使用的手段。结果表明快速病毒检测可能有益，但由于样本量不足，在统计学上不显著。需要开展一项针对这些结果指标的大型试验。
