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Point-of-care testing for respiratory pathogens did not reduce antibiotic use in children or improve outcomes
Question clinique
Does point-of-care polymerase chain reaction testing for respiratory pathogens reduce antibiotic use in acutely ill children?
L’Essentiel
This study found no evidence that point-of-care testing for respiratory pathogens reduced the use of antibiotics for acutely ill children with respiratory signs and symptoms who present to the pediatric ED. The length-of-stay in the ED was approximately 13 minutes longer in children who underwent point-of-care testing, but there were no differences in the use of other diagnostic tests or imaging, hospital admissions, or return visits to the ED. (LOE = 1b)
Overuse alert: This POEM aligns with Choosing Wisely Canada’s Using Antibiotics Wisely campaign. The Choosing Wisely Canada Cold Standard toolkit provides tools for reducing unnecessary antibiotics.
Référence
Plan de l'etude: Randomized controlled trial (nonblinded)
Financement: Foundation
Cadre: Emergency department
Sommaire
These investigators identified children, up to 17 years old, presenting to the pediatric emergency department (ED) with fever or any respiratory signs or symptoms. A total of 1243 patients randomly received (concealed) allocation to undergo multiplex polymerase chain reaction (PCR) point-of-care testing upon arrival or usual care. The PCR test can identify 18 respiratory viruses and 3 bacteria with results available within 70 minutes. Children in the usual care group underwent testing, including the same multiplex PCR test, at the discretion of the ED physician, with the results available the next day. Rapid testing for influenza and respiratory syncytial virus was available for both groups with results obtained in 3 hours. Complete follow-up occurred for all participants at one month. Using intention-to-treat analyses, multiplex PCR point-of-care testing for respiratory pathogens did not significantly reduce the primary outcome of antibiotic prescriptions between the intervention and control groups (27.3% vs 28.5%, respectively). Although the ED length of stay was approximately 13 minutes longer in the intervention group than in the control group, no group differences occurred in the numbers of diagnostic tests or radiographic images, hospital admissions, or ED returns.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Commentaires
Surprised
Seems counterintuitive - as if the test results were completely disregarded.