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Katherine A. Poehling, MD, MPH; Yuwei Zhu, MD, MS; Yi-Wei Tang, MD, PhD; Kathryn Edwards, MD

Arch Pediatr Adolesc Med. 2006;160:713-718.

Objective  To determine whether a point-of-care rapid influenza test impacts the diagnostic evaluation and treatment of children with acute respiratory illnesses.

Design  Randomized controlled trial.

Setting  Pediatric emergency department and acute care clinic of a children's hospital.

Participants  Children aged younger than 5 years with fever or acute respiratory symptoms during 2 influenza seasons (2002 through 2004).

Interventions  Surveillance days were randomized to performance or no performance of a point-of-care rapid influenza test. All children had a nasal and throat swab obtained for laboratory tests. The rapid test group had another nasal swab obtained for the QuickVue Influenza Test (Quidel Corp, San Diego, Calif), which was performed by nurses; results were shared immediately with treating physicians.

Main Outcome Measures  Rapid test results were compared with results of the viral culture or 2 polymerase chain reaction assays for influenza. Diagnostic test ordering and antibiotic prescribing were compared for the groups.

Results  Of 468 enrolled children, 306 were from the emergency department and 162 from the clinic. Overall, 88 children (19%) had influenza infection. Of 205 children in the rapid test group, 51 (25%) had influenza infection. The rapid influenza test was 82% sensitive and 99% specific. In the emergency department, fewer children in the rapid test group had diagnostic tests ordered than in the no rapid test group (39% vs 51%, P = .03). There was no difference in test ordering in the clinic or in antibiotic prescribing in either setting. The use of antivirals was low.

Conclusions  Point-of-care rapid influenza tests were sensitive and specific and were associated with less diagnostic testing in the emergency department.

Author Affiliations: Departments of Pediatrics (Drs Poehling and Edwards), Biostatistics (Dr Zhu), and Medicine (Dr Tang), Vanderbilt University Medical Center, Nashville, Tenn.

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