Verhees Ruud A F, Lutgens Suzanne P M, Kusters Ron, Dinant Geert-Jan, Cals Jochen W L
Universiteit Maastricht, School for Public Health and Primary Care (CAPHRI), Maastricht.
Contact: R.A.F. Verhees (
Ned Tijdschr Geneeskd. 2019 Aug 29;163:D3806.
An influenza epidemic can greatly increase the workload in primary care and the emergency department (ED) and can even disrupt the healthcare system. It is difficult to diagnose influenza by history taking and physical examination. A fast diagnosis usinginfluenza point-of-care tests (POCTs) could reduce unnecessary antibiotic prescriptions, diagnostic tests, consultations and hospital admissions. Moreover, length of stay on EDs and length of admission could be shortened. The analytical accuracy of antigen detection tests for influenza is relatively low compared to the well performing RT-PCR assays (sensitivity and specificity approximately 95%). Only 1 randomized controlled trial has shown the effect of a (combined) RT-PCR assay for influenza detection on clinically relevant outcome measures. Observational research suggests that introduction of RT-PCR assays for influenza detection reduces length of stay on the ED and decreased time from sample reception to result. For practical reasons, we should embrace the introduction of RT-PCR assays for influenza detection on EDs. Before POCTs can be implemented in primary care (family medicine) the analytical accuracy and time to receive results should be improved and effects of its clinical impact should be proven.
流感流行会大幅增加基层医疗和急诊科的工作量,甚至可能扰乱医疗系统。通过病史采集和体格检查很难诊断流感。使用流感即时检验(POCT)进行快速诊断可减少不必要的抗生素处方、诊断检查、会诊和住院治疗。此外,还可缩短在急诊科的留观时间和住院时间。与性能良好的逆转录聚合酶链反应(RT-PCR)检测相比,流感抗原检测试验的分析准确性相对较低(敏感性和特异性约为95%)。仅有1项随机对照试验显示了(联合)RT-PCR流感检测试验对临床相关结局指标的影响。观察性研究表明,采用RT-PCR流感检测试验可缩短在急诊科的留观时间,并减少从接收样本到出结果的时间。出于实际原因,我们应在急诊科采用RT-PCR流感检测试验。在基层医疗(家庭医学)中实施POCT之前,应提高其分析准确性和出结果时间,并证明其临床影响效果。