Burrowes Shana A B, Rader Alec, Ni Pengsheng, Drainoni Mari-Lynn, Barlam Tamar F
Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.
Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA.
Open Forum Infect Dis. 2020 Mar 3;7(3):ofaa057. doi: 10.1093/ofid/ofaa057. eCollection 2020 Mar.
Rapid diagnostic tests (RDTs) have been developed with the aim of providing accurate results in a timely manner. Despite this, studies report that provider uptake remains low.
We conducted a retrospective analysis of ambulatory, urgent care, and emergency department (ED) encounters at an urban safety net hospital with a primary diagnosis of an upper or lower respiratory tract infection (eg, bronchitis, pharyngitis, acute sinusitis) from January 1, 2016, to December 31, 2018. We collected RDT type and results, antibiotics prescribed, demographic and clinical patient information, and provider demographics.
RDT use was low; a test was performed at 29.5% of the 33494 visits. The RDT most often ordered was the rapid Group A (GAS) test (n = 7352), predominantly for visits with a discharge diagnosis of pharyngitis (n = 5818). Though antibiotic prescription was more likely if the test was positive (relative risk [RR], 1.68; 95% confidence interval [CI], 1.58-1.8), 92.46% of streptococcal pharyngitis cases with a negative test were prescribed an antibiotic. The Comprehensive Respiratory Panel (CRP) was ordered in 2498 visits; influenza was the most commonly detected pathogen. Physicians in the ED were most likely to order a CRP. Antibiotic prescription was lower if the CRP was not ordered compared with a negative CRP result (RR, 0.77; 95% CI, 0.7-0.84). There was no difference in prescribing by CRP result (negative vs positive).
RDTs are used infrequently in the outpatient setting, and impact on prescribing was inconsistent. Further work is needed to determine barriers to RDT use and to address potential solutions.
快速诊断检测（RDT）的开发旨在及时提供准确结果。尽管如此，研究报告称医疗服务提供者对其采用率仍然很低。
我们对一家城市安全网医院2016年1月1日至2018年12月31日期间门诊、紧急护理和急诊科就诊病例进行了回顾性分析，这些病例的主要诊断为上呼吸道或下呼吸道感染（如支气管炎、咽炎、急性鼻窦炎）。我们收集了RDT类型和结果、开具的抗生素、患者人口统计学和临床信息以及医疗服务提供者的人口统计学信息。
RDT的使用频率较低；在33494次就诊中，有29.5%进行了检测。最常开具的RDT是A组链球菌（GAS）快速检测（n = 7352），主要用于出院诊断为咽炎的就诊病例（n = 5818）。尽管检测呈阳性时更有可能开具抗生素（相对风险[RR]，1.68；95%置信区间[CI]，1.58 - 1.8），但检测结果为阴性的链球菌咽炎病例中有92.46%仍开具了抗生素。在2498次就诊中开具了综合呼吸检测板（CRP）；流感是最常检测到的病原体。急诊科医生最有可能开具CRP。与CRP结果为阴性相比，如果未开具CRP，抗生素处方率较低（RR，0.77；95% CI，0.7 - 0.84）。CRP结果为阴性与阳性时的处方情况没有差异。
RDT在门诊环境中使用频率不高，对处方的影响也不一致。需要进一步开展工作以确定RDT使用的障碍并探讨潜在的解决方案。
