Meltzer Andrew C, Loganathan Aditya, Moran Seamus, Shahamatdar Soroush, Dominguez Luis W, Willis Joel, Zhang Wei, Zhang Xinyi, Ma Yan
Department of Emergency Medicine The George Washington University School of Medicine and Health Sciences Washington District of Columbia USA.
Department of Mathematics and Statistics University of Arkansas Little Rock Little Rock Arkansas USA.
J Am Coll Emerg Physicians Open. 2024 Oct 23;5(5):e13306. doi: 10.1002/emp2.13306. eCollection 2024 Oct.
Syndromic assessment with multiplex polymerase chain reaction (mPCR) testing in patients with acute respiratory illness (ARI) allows for simultaneous identification of multiple possible infectious etiologies. Point-of-care (POC) syndromic assessment can be conducted in a clinical setting, such as an urgent care center (UCC), without requiring certified laboratories. The primary objective of this study was to determine whether POC syndromic assessment improved patient satisfaction for patients seen at an UCC with ARI; secondary objectives included whether syndromic assessment reduced self-isolation time, increased diagnostic confidence, and reduced overall antibiotic utilization.
We conducted an unblinded multicenter randomized controlled trial on UCC patients with an ARI. Patients were randomized to either SC (defined as standard UCC testing for ARI) or syndromic assessment with POC mPCR. Patients were surveyed for patient satisfaction, self-isolation plans, diagnostic confidence, and overall antibiotic utilization.
Among the 360 patients enrolled, those in the syndromic assessment group were more satisfied with the time required to communicate the results (98.4% vs. 42.4%, < 0.001) on day of treatment, more likely to resume normal activities sooner (83.3% vs. 69.4%, = 0.039), and more confident in their illness cause (60.7% vs. 29.6%, < 0.001); however, the rate of antibiotic utilization did not differ (33.5% vs. 26%, = 1.0).
In conclusion, our study provides evidence supporting the use of syndromic assessment in UCCs for ARI diagnosis, including patient-centered outcomes such as greater confidence in diagnosis and more efficient isolation strategies. This study did not show a difference in more clinically oriented outcomes, such as a change in antibiotic utilization. Future studies should identify clinical care pathways to improve antibiotic stewardship for likely viral syndromes and whether the increased initial cost of syndromic assessment is offset by the clinical benefits and subsequent cost savings.
对急性呼吸道疾病（ARI）患者进行多重聚合酶链反应（mPCR）检测的综合征评估，可同时识别多种可能的感染病因。即时检验（POC）综合征评估可在临床环境中进行，如紧急护理中心（UCC），无需认证实验室。本研究的主要目的是确定POC综合征评估是否能提高在UCC就诊的ARI患者的满意度；次要目标包括综合征评估是否减少自我隔离时间、增强诊断信心并降低总体抗生素使用率。
我们对UCC的ARI患者进行了一项非盲多中心随机对照试验。患者被随机分为SC组（定义为ARI的标准UCC检测）或POC mPCR综合征评估组。对患者进行了患者满意度、自我隔离计划、诊断信心和总体抗生素使用率的调查。
在纳入的360名患者中，综合征评估组的患者对治疗当天传达结果所需时间更满意（98.4%对42.4%，<0.001），更有可能更快恢复正常活动（83.3%对69.4%，=0.039），对病因更有信心（60.7%对29.6%，<0.001）；然而，抗生素使用率没有差异（33.5%对26%，=1.0）。
总之，我们的研究提供了证据支持在UCC中使用综合征评估进行ARI诊断，包括以患者为中心的结果，如对诊断更有信心和更有效的隔离策略。这项研究没有显示出在更侧重于临床的结果方面存在差异，如抗生素使用率的变化。未来的研究应确定临床护理途径，以改善对可能的病毒综合征的抗生素管理，以及综合征评估增加的初始成本是否被临床益处和随后的成本节省所抵消。
