Schober, Tilmann, Wong, Kimberly, DeLisle, Gaëlle, Caya, Chelsea, Brendish, Nathan J., Clark, Tristan W., Dendukuri, Nandini, Doan, Quynh, Fontela, Patricia, Gore, Genevieve, Li, Patricia, McGreer, Allison, Noël, Kim Chloe, Robinson, Joan L., Suarthana, Eva and Papenburg, Jesse (2024) Clinical outcomes of rapid respiratory virus testing in emergency departments: a systematic review and meta-analysis. JAMA Internal Medicine. (doi:10.1001/jamainternmed.2024.0037).
Abstract
Background: rapid tests for respiratory viruses, including multiplex panels, are increasingly available in Emergency Departments (ED). Their impact on patient outcomes remains unclear.
Objectives: to determine if ED rapid respiratory virus testing in patients with suspected acute respiratory infection (ARI) decreases antibiotic use, ancillary tests, ED length of stay, ED return visits and hospitalization and increases influenza antiviral treatment.
Data sources: we searched Ovid MEDLINE, Embase (Ovid), Scopus, and Web of Science from 1985 to November 14, 2022.
Study selection: we included randomized controlled trials of patients of any age with ARI in an ED. The primary intervention was rapid viral testing.
Extraction, data and synthesis: in this systematic review and meta-analysis, PRISMA reporting guidelines were followed. Two independent reviewers extracted data and assessed risk of bias using Cochrane’s Risk of Bias 2.0. Estimates were pooled using random-effects models. Quality of evidence was assessed using the GRADE framework.
Main outcomes and measures: antibiotic use and secondary outcomes were pooled separately as risk ratio (RR) and risk difference estimates with 95% confidence intervals [CI]s.
Results: of 7157 studies identified, 11 (n=6068 patients) were included in pooled analyses. Routine rapid viral testing did not impact antibiotic use (RR 0.99; 95% CI 0.93-1.05; high certainty) but was associated with higher use of influenza antivirals (RR 1.33; 95% CI 1.02-1.75; moderate certainty) and lower use of chest radiography (0.88; 95% CI 0.79-0.98; moderate certainty) and blood tests (RR 0.81; 95% CI 0.69-0.97; moderate certainty). There was no association with urine testing (RR 0.95; 95% CI 0.77-1.07; low certainty), ED length of stay (0h; 95% CI -0.17h-0.16h; moderate certainty), return visits (RR 0.93; 95% CI 0.79-1.08; moderate certainty) or hospitalization (RR 1.01; 95% CI 0.95-1.0 high certainty). Adults represented 16% of participants. There was no effect of viral testing on antibiotic use in any prespecified subgroup by age, test method, publication date, number of viral targets, risk of bias, and industry funding.
Conclusions and relevance: available evidence shows limited benefits of routine viral testing in EDs for patients with ARI. Further studies in adults, especially those with high-risk conditions, are warranted.
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