系统评价即时检测流感对急性呼吸道感染患者结局的影响。
Systematic review of the impact of point-of-care testing for influenza on the outcomes of patients with acute respiratory tract infection.
机构信息
Virology Research Laboratory, Prince of Wales Hospital, University of New South Wales, Sydney, NSW, Australia.
Australian Centre for NanoMedicine and School of Chemistry, Faculty of Science, University of New South Wales, Sydney, NSW, Australia.
出版信息
Rev Med Virol. 2018 Sep;28(5):e1995. doi: 10.1002/rmv.1995. Epub 2018 Aug 13.
Acute respiratory tract infections are a major cause of morbidity and mortality and represent a significant burden on the health care system. Laboratory testing is required to definitively distinguish infecting influenza virus from other pathogens, resulting in prolonged emergency department (ED) visits and unnecessary antibiotic use. Recently available rapid point-of-care tests (POCT) may allow for appropriate use of antiviral and antibiotic treatments and decrease patient lengths of stay. We undertook a systematic review to assess the effect of POCT for influenza on three outcomes: (1) antiviral prescription, (2) antibiotic prescription, and (3) patient length of stay in the ED. The databases Medline and Embase were searched using MeSH terms and keywords for influenza, POCT, antivirals, antibiotics, and length of stay. Amongst 245 studies screened, 30 were included. The majority of papers reporting on antiviral prescription found that a positive POCT result significantly increased use of antivirals for influenza compared with negative POCT results and standard supportive care. A positive POCT result also led to decreased antibiotic use. The results of studies assessing the effect of POCT on ED length of stay were not definitive. The studies assessed in this systematic review support the use of POCT for diagnosis of influenza in patients suffering an acute respiratory infection. Diagnosis using POCT may lead to more appropriate prescription of treatments for infectious agents. Further studies are needed to assess the effect of POCT on the length of stay in ED.
急性呼吸道感染是发病率和死亡率的主要原因,对医疗保健系统造成了重大负担。实验室检测对于明确区分感染流感病毒与其他病原体至关重要,这导致急诊科就诊时间延长和不必要的抗生素使用。最近可用的即时检测(POCT)可能允许适当使用抗病毒和抗生素治疗,并缩短患者在急诊科的停留时间。我们进行了一项系统评价,以评估 POCT 对流感的三个结果的影响:(1)抗病毒药物处方,(2)抗生素处方,和(3)患者在急诊科的停留时间。使用流感、POCT、抗病毒药物、抗生素和停留时间的 MeSH 术语和关键字在 Medline 和 Embase 数据库中进行搜索。在筛选的 245 项研究中,有 30 项被纳入。大多数报告关于抗病毒药物处方的论文发现,与阴性 POCT 结果和标准支持性护理相比,POCT 阳性结果显著增加了流感患者使用抗病毒药物的比例。POCT 阳性结果也导致抗生素使用减少。评估 POCT 对急诊科停留时间影响的研究结果并不明确。本系统评价中评估的研究支持 POCT 用于诊断急性呼吸道感染患者的流感。使用 POCT 进行诊断可能会导致更合理地针对感染病原体进行治疗。需要进一步研究来评估 POCT 对急诊科停留时间的影响。