Clinical decision making in the emergency department setting using rapid PCR: Results of the CLADE study group
| Autor: | Marcia A. Deike, Johanna C. Moore, Tami Gooch, Diane Hirigoyen, Glen Hansen, Kevan L. Hanson, Emily Herding |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
0301 basic medicine medicine.medical_specialty Adolescent Point-of-Care Systems Testing Clinical Decision-Making 030106 microbiology RT-PCR Influenza season Physician Decision Sensitivity and Specificity Article Patient care Young Adult 03 medical and health sciences 0302 clinical medicine Clinical decision making Virology Influenza Human medicine Humans Prospective Studies 030212 general & internal medicine Child Prospective cohort study Aged Aged 80 and over Emergency department Reverse Transcriptase Polymerase Chain Reaction business.industry Infant Middle Aged Rapid Influenza Liat Patient management Cost savings Influenza B virus Infectious Diseases Influenza A virus Child Preschool Emergency medicine Emergency Service Hospital business |
| Zdroj: | Journal of Clinical Virology |
| ISSN: | 1386-6532 |
| DOI: | 10.1016/j.jcv.2018.02.013 |
| Popis: | Highlights • The influence of an influenza diagnosis on patient managed during ED visits is examined. • An influenza diagnosis in the ED is actionable, impacting empiric management in 61% of cases. • The clinical diagnosis of influenza, based on presenting symptoms, lacks sensitivity at 36%. • A 30 min result from collection to report could be achieved in the ED for 91.7%, of cases tested. • ED testing resulted in savings of $200.40/ED visit but is dependent on avoiding planned admissions. Background Emergency Departments (ED) are challenged during influenza season by patients who present acutely during sporadic ED visits. ED management is largely empiric, often occurring without reliable diagnostics needed for targeted therapies, safe outpatient discharge, or hospital admissions. Objective To evaluate the impact of the influenza diagnosis on physician decision making during ED visits using the Cobas Liat® influenza A + B assay. Study design Prospective study assessing the impact of rapid ( $578,000 due to deferred admissions, and reduction in antiviral prescribing. Sensitivity of ED-based influenza testing using the Cobas Liat® assay was equivalent to centralized lab testing at 98.8% sensitivity and 98.5% specificity respectively. Conclusion Providing rapid, RT-PCR influenza testing to ED settings is actionable and used to guide patient care decisions. Understanding the cascade of events linked to the influenza diagnosis in the ED provides overall cost savings which offset the cost of providing ED-based testing. |
| Databáze: | OpenAIRE |
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