Clin Infect Dis . The Influence of Rapid Influenza Diagnostic Testing on Clinician Decision-making for Patients with Acute Respiratory Infection in Urgent Care

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Clin Infect Dis


. 2023 Feb 1;ciad038.
doi: 10.1093/cid/ciad038. Online ahead of print.
The Influence of Rapid Influenza Diagnostic Testing on Clinician Decision-making for Patients with Acute Respiratory Infection in Urgent Care


Brian D Stamm ¹ , John Tamerius ² , Sush Reddy ² , Shari Barlow ³ , Caroline Hamer ³ , Ashley Kempken ³ , Maureen Goss ³ , Cecilia He ³ , Cristalyne Bell ³ , Mitchell Arnold ³ , Mary Checovich ³ , Emily Temte ³ , Derek Norton ³ , Guanhua Chen ³ , Jeffrey Baltus ³ , Emily S Gurley ⁴ , Jonathan L Temte ³



Affiliations

• PMID: 36723863
• DOI: 10.1093/cid/ciad038

Abstract

Background: The potential benefits of utilizing rapid influenza diagnostic tests (RIDT) in urgent care facilities on clinical care and prescribing practices are understudied. We compared antiviral and antibiotic prescribing, imaging, and laboratory ordering in clinical encounters with and without RIDT results.
Methods: Our study compared patients with acute respiratory infection (ARI) symptoms who received an RIDT and patients who did not at two urgent care facilities. Primary analysis using one-to-one exact matching resulted in 1145 matched pairs to which McNemar's 2x2 tests were used to assess association between the likelihood of prescribing, imaging or laboratory ordering, and RIDT use. Secondary analysis compared the same outcomes using logistic regression among the RIDT-tested population between participants who tested negative (RIDT(-)) and positive (RIDT(+)).
Results: Primary analysis identified that compared to patients without RIDT testing, RIDT(+) patients were more likely to be prescribed antivirals (OR:10.23; 95% CI:5.78-19.72) and less likely to be prescribed antibiotics (OR:0.15; 95% CI:0.08-0.27). Comparing all RIDT-tested participants to all non-RIDT-tested participants, RIDT use increased antiviral prescribing odds (OR:3.07; 95% CI:2.25-4.26) and reduced antibiotic prescribing odds (OR:0.52; 95% CI:0.43-0.63). The secondary analysis identified an increased odds of prescribing antivirals (OR:28.21; 95% CI:18.15-43.86; P <0.0001) and a decreased odds of prescribing antibiotics (OR:0.20; 95% CI:0.13-0.30; P <0.0001) for RIDT(+) participants compared to RIDT(-).
Conclusions: Utilization of RIDTs in patients presenting to urgent care with ARI symptoms influences clinician diagnostic and treatment decision-making, which could lead to improved patient outcomes, population-level reductions in influenza burden, and a decreased threat of antibiotic resistance.

Keywords: acute respiratory infection; antibiotic resistance; antiviral and antibiotic prescribing; influenza; rapid influenza diagnostic test.