Can Influenza Point-of-Care Tests Reduce Diagnostic Uncertainty?

Influenza point-of-care tests (POCTs) influence clinical decisions in ambulatory care—particularly among pediatric patients—and may reduce the risk for routine blood tests, blood cultures, and chest radiography, according to a new systematic review.

To compare the impact of POCTs and usual care on prescribing and testing decisions in ambulatory settings, the researchers analyzed 7 randomized studies and 6 non-randomized studies identified from across 6 databases. In all, the researchers screened 12,928 citations—4324 of which were from randomized studies, and 4774 of which were from non-randomized studies.

IF YOU LIKE THIS, READ MORE...

Interactive Quiz: Is It an Infection?

Novel Indicator of Influenza Immunity Identified

According to the review’s authors, most of the citations were from pediatric emergency departments.

Among the randomized trials—which had a moderate risk for bias—POCTs had no effect on admissions, returning for care, or antibiotic prescribing. However, more antivirals were prescribed in these studies.

The randomized trials also demonstrated that POCTs reduced additional testing for routine blood tests by 20%, blood cultures by 18%, and chest radiography by 19%. POCTs had no effect on the occurrence of urinalysis or time in the emergency department.

“These results suggest POCTs have a role in reducing diagnostic uncertainty for children with influenza-like illnesses, but the impact on patient outcomes remains unclear,” the study authors wrote.

Fewer non-randomized studies—which had a higher risk of bias than the randomized trials—resulted in these outcomes. In fact, the findings were reversed or attenuated in some of the non-randomized trials, including a decrease in the number of antibiotics prescribed and urinalyses performed. 

“Point-of-care testing for influenza influences prescribing and testing decisions, particularly for children in emergency departments,” the researchers concluded. “Observational evidence shows challenges for real-world implementation.”

—Colleen Murphy

Reference:

Lee JJ, Verbakel JY, Goyder CR, et al. The clinical utility of point-of-care tests for influenza in ambulatory care: a systematic review and meta-analysis. Clin Infect Dis. 2019;69(1):24-33. https://doi.org/10.1093/cid/ciy837.