Emergency and Acute Medicine, Campus Virchow Klinikum and Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany.
Influenza Other Respir Viruses. 2021 Sep;15(5):608-617. doi: 10.1111/irv.12857. Epub 2021 Apr 4.
Seasonal influenza is a burden for emergency departments (ED). The aim of this study was to investigate whether point-of-care (POC) PCR testing can be used to reduce staff sick days and improve diagnostic and therapeutic procedures.
The aim of this study was to investigate whether point-of-care (POC) PCR testing can be used to reduce staff sick days and improve diagnostic and therapeutic procedures.
Using a cross-over design, the cobas® Liat® Influenza A/B POC PCR test (Liat) was compared with standard clinical practice during the 2019/2020 influenza season. All adult patients (aged ≥ 18 years) with fever (≥38°C) and respiratory symptoms were included. Primary end points were the prevalence of influenza infections in the ED and staff sick days. Secondary end points were frequency of antiviral and antibacterial therapy, time between admission and test result or treatment initiation, patient disposition, ED length of stay (LOS), and for inpatients mortality and LOS. Nurses were interviewed about handling and integration of POC testing. The occurrence of SARS-CoV-2 infections coincided with the second half of the study.
A total of 828 patients were enrolled in the study. All 375 patients of the intervention group were tested with Liat, and 103 patients of them (27.6%) tested positive. During the intervention period, staff sick days were reduced by 34.4% (P = .023). Significantly, more patients in the intervention group received antiviral therapy with neuraminidase inhibitors (7.2% vs 3.8%, P = .028) and tested patients received antibiotics more frequently (40.0% vs 31.6%, P = .033). Patients with POC test were transferred to external hospitals significantly more often (5.6% vs 1.3%, P = .01).
We conclude that POC testing for influenza is useful in the ED, especially if it is heavily frequented by patients with respiratory symptoms.
季节性流感给急诊科带来了负担。本研究旨在探讨即时检测（POC）PCR 检测是否可用于减少员工病假天数并改善诊断和治疗流程。
本研究旨在探讨即时检测（POC）PCR 检测是否可用于减少员工病假天数并改善诊断和治疗流程。
本研究采用交叉设计，在 2019/2020 流感季节，使用 cobas® Liat® 流感 A/B POC PCR 检测（Liat）与标准临床实践进行比较。所有因发热（≥38°C）和呼吸道症状而就诊的成年患者（年龄≥18 岁）均纳入研究。主要终点为急诊科流感感染的流行率和员工病假天数。次要终点为抗病毒和抗菌治疗的频率、从入院到检测结果或开始治疗的时间、患者去向、急诊科住院时间（LOS）以及住院患者的死亡率和 LOS。对护士进行了有关即时检测操作和整合的访谈。SARS-CoV-2 感染与研究的后半部分同时发生。
共纳入 828 例患者。干预组的所有 375 例患者均接受了 Liat 检测，其中 103 例（27.6%）检测结果阳性。在干预期间，员工病假天数减少了 34.4%（P=.023）。重要的是，干预组接受神经氨酸酶抑制剂抗病毒治疗的患者比例显著增加（7.2%比 3.8%，P=.028），接受检测的患者接受抗生素治疗的频率也更高（40.0%比 31.6%，P=.033）。接受即时检测的患者更多地转往外部医院（5.6%比 1.3%，P=.01）。
我们得出结论，即时检测流感对急诊科非常有用，尤其是在呼吸症状患者就诊较多的情况下。
