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Clinical impact of a routine, molecular, point-of-care, test-and-treat strategy for influenza in adults admitted to hospital (FluPOC): a multicentre, open-label, randomised controlled trial

Clinical impact of a routine, molecular, point-of-care, test-and-treat strategy for influenza in adults admitted to hospital (FluPOC): a multicentre, open-label, randomised controlled trial
Clinical impact of a routine, molecular, point-of-care, test-and-treat strategy for influenza in adults admitted to hospital (FluPOC): a multicentre, open-label, randomised controlled trial
Background The diagnosis of Influenza in hospitalised patients is delayed due to long turnaround times with laboratory testing, leading to inappropriate and late antiviral and isolation facility use. Molecular point-of-care test (mPOCT) are highly accurate, easy to use and generate results in under 1 hour but high quality evidence for their clinical impact is lacking. The aim of this study was to evaluate the clinical impact of routine mPOCT on influenza detection, antiviral use, infection control measures and clinical outcome, in adults hospitalised with acute respiratory illness. Methods In this multicentre, randomised controlled trial we enrolled adults hospitalised with acute respiratory illness during influenza seasons. Patients were randomised (1:1) to receive mPOCT for influenza or routine clinical care. The primary outcome was the proportion of influenza-infected patients who received antivirals. Secondary outcomes included time to antivirals, isolation facility use, and clinical outcomes. This study is registered with ISRCTN:17197293 and has completed. Findings Between December 2017 and May 2019, 613 patients were enrolled (307 assigned to mPOCT and 306 to routine care) and all were analysed. 100 (33%) of 307 patients in the mPOCT group and 102 (33%) of 306 in the control group had influenza. 100 (100%) of 100 influenza-infected patients were diagnosed in the mPOCT group and 60 (59%) of 102 were diagnosed though routine clinical care (relative risk 1·7, 95%CI 1·7 to 1·7; p<0·0001). 99 (99%) of 100 influenza-infected patients received antivirals in the mPOCT group versus 63 (62%) 102 in the control group (relative risk 1·6, 95%CI 1·4 to 1·9; p<0·0001). Median time to antivirals was 1·0 hour in the mPOCT group versus 6·0 hours in the control group (difference of 5·0 hours, 95%CI 0 to 6·0; p=0·004). 70 (70%) of 100 influenza-infected patients in the mPOCT group were nursed in single room accommodation versus 39 (38%) of 102 in the control group (relative risk 1·8, 95%CI 1·4 to 2·4; p<0·0001). Interpretation Routine mPOCT for influenza was associated with improved influenza detection and improvements in appropriate and timely antiviral and isolation facility use. Routine mPOCT should replace laboratory based diagnostics for acute admissions to hospital during influenza season. Funding NIHR
2213-2600
1-11
Clark, Tristan
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Beard, Kate
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Brendish, Nathan
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Malachira, Ahalya
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Mills, Samuel
bf3525fe-f39a-4896-8ee3-5b60ad704b6f
Chan, Cathleen
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Poole, Stephen
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Ewings, Sean
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Cortes, Nicholas
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Nyimbili, Esther
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Presland, Laura
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Clark, Tristan
712ec18e-613c-45df-a013-c8a22834e14f
Beard, Kate
85604fec-3541-48cb-9abf-a76c2a32c3f1
Brendish, Nathan
a8a4189e-01eb-4ab3-933e-a24cd188a4d7
Malachira, Ahalya
dd1d5b84-f338-44a5-9429-3e3e93a1c953
Mills, Samuel
bf3525fe-f39a-4896-8ee3-5b60ad704b6f
Chan, Cathleen
7dee73d4-6074-4f28-bb2a-43c33b3f51db
Poole, Stephen
440d7904-ab72-469c-892b-c910cd1cb19b
Ewings, Sean
326656df-c0f0-44a1-b64f-8fe9578ca18a
Cortes, Nicholas
28c043ce-05bf-433e-a0da-2e6ae8de46c5
Nyimbili, Esther
29994ea1-79be-4d3a-b81c-55d334d14a3d
Presland, Laura
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Clark, Tristan, Beard, Kate, Brendish, Nathan, Malachira, Ahalya, Mills, Samuel, Chan, Cathleen, Poole, Stephen, Ewings, Sean, Cortes, Nicholas, Nyimbili, Esther and Presland, Laura (2020) Clinical impact of a routine, molecular, point-of-care, test-and-treat strategy for influenza in adults admitted to hospital (FluPOC): a multicentre, open-label, randomised controlled trial. The Lancet Respiratory Medicine, 0, 1-11. (doi:10.1016/S2213-2600(20)30469-0).

Record type: Article

Abstract

Background The diagnosis of Influenza in hospitalised patients is delayed due to long turnaround times with laboratory testing, leading to inappropriate and late antiviral and isolation facility use. Molecular point-of-care test (mPOCT) are highly accurate, easy to use and generate results in under 1 hour but high quality evidence for their clinical impact is lacking. The aim of this study was to evaluate the clinical impact of routine mPOCT on influenza detection, antiviral use, infection control measures and clinical outcome, in adults hospitalised with acute respiratory illness. Methods In this multicentre, randomised controlled trial we enrolled adults hospitalised with acute respiratory illness during influenza seasons. Patients were randomised (1:1) to receive mPOCT for influenza or routine clinical care. The primary outcome was the proportion of influenza-infected patients who received antivirals. Secondary outcomes included time to antivirals, isolation facility use, and clinical outcomes. This study is registered with ISRCTN:17197293 and has completed. Findings Between December 2017 and May 2019, 613 patients were enrolled (307 assigned to mPOCT and 306 to routine care) and all were analysed. 100 (33%) of 307 patients in the mPOCT group and 102 (33%) of 306 in the control group had influenza. 100 (100%) of 100 influenza-infected patients were diagnosed in the mPOCT group and 60 (59%) of 102 were diagnosed though routine clinical care (relative risk 1·7, 95%CI 1·7 to 1·7; p<0·0001). 99 (99%) of 100 influenza-infected patients received antivirals in the mPOCT group versus 63 (62%) 102 in the control group (relative risk 1·6, 95%CI 1·4 to 1·9; p<0·0001). Median time to antivirals was 1·0 hour in the mPOCT group versus 6·0 hours in the control group (difference of 5·0 hours, 95%CI 0 to 6·0; p=0·004). 70 (70%) of 100 influenza-infected patients in the mPOCT group were nursed in single room accommodation versus 39 (38%) of 102 in the control group (relative risk 1·8, 95%CI 1·4 to 2·4; p<0·0001). Interpretation Routine mPOCT for influenza was associated with improved influenza detection and improvements in appropriate and timely antiviral and isolation facility use. Routine mPOCT should replace laboratory based diagnostics for acute admissions to hospital during influenza season. Funding NIHR

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FluPOC paper Lancet RM accepted version - Accepted Manuscript
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Accepted/In Press date: 6 October 2020
e-pub ahead of print date: 4 December 2020

Identifiers

Local EPrints ID: 444918
URI: http://eprints.soton.ac.uk/id/eprint/444918
ISSN: 2213-2600
PURE UUID: bed34d05-01ac-4d7b-bca4-949990c8ea05
ORCID for Tristan Clark: ORCID iD orcid.org/0000-0001-6026-5295
ORCID for Nathan Brendish: ORCID iD orcid.org/0000-0002-9589-4937
ORCID for Sean Ewings: ORCID iD orcid.org/0000-0001-7214-4917

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Date deposited: 11 Nov 2020 17:32
Last modified: 28 Apr 2022 06:38

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Contributors

Author: Tristan Clark ORCID iD
Author: Kate Beard
Author: Nathan Brendish ORCID iD
Author: Ahalya Malachira
Author: Samuel Mills
Author: Cathleen Chan
Author: Stephen Poole
Author: Sean Ewings ORCID iD
Author: Nicholas Cortes
Author: Esther Nyimbili
Author: Laura Presland

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