Few Benefits Observed with Rapid Respiratory Virus Testing in Emergency Departments

Tilmann Schober, MD

Credit: X (Twitter)

There are few benefits to routine respiratory virus testing within emergency departments (EDs) for individuals that have acute respiratory infection (ARI), according to recent findings, though additional research in adults with high-risk conditions may be necessary.¹

These findings were the product of a recent systematic review and meta-analysis looking into whether emergency department rapid respiratory virus testing among those suspected to have acute respiratory infection (ARI) was connected to diminished antibiotic use, return visits and hospitalization, department stay length, and other outcomes.

This research was led by Tilmann Schober, MD, McGill University’s department of pediatrics in Montreal, Quebec. Schober and colleagues acknowledged that testing had become more widely available in emergency departments, though patient outcomes with testing had remained less clear.²

“This systematic review and meta-analysis aimed to determine if the use of rapid respiratory viral diagnostic testing in patients of all ages presenting in the ED for ARI was associated with decreased ED antibiotic prescribing and other clinically relevant outcomes,” Schober and colleagues wrote.

Background and Methods

The investigators collaborated with a medical librarian, forming an electronic search strategy and implementing the Ovid MEDLINE, Scopus, Embase (Ovid), and Web of Science Core Collection. Further research was evaluated through the screening of reference lists of included reviews and studies.

The research team first looked at observational studies and randomized controlled trials (RCTs), though they later refined their search to look solely on RCTs by November 2022. The team’s RCT definition included both full RCTs with patient-level randomization and quasi-RCTs with quasi-random methods of allocation.

Studies deemed by the investigators to be eligible assessed individuals of all ages presenting in emergency departments with acute respiratory infections involving respiratory symptoms that suggested infection. The team excluded research aimed at populations with specific chronic health issues.

The research team determined their primary intervention to involve availability of rapid respiratory virus testing or the treating clinician’s knowledge of rapid test results. The team decided secondary interventions would include virus test positivity versus negativity.

The investigators’ primary outcome they evaluated was a link with antibiotic prescription at the time of patients’ visits to emergency departments, and their secondary outcomes were department length of stay, ancillary testing, use of influenza antivirals, return visits to departments, or hospitalization. The team’s extraction of data and risk of bias evaluations were done by 2 independent reviewers.

Findings

Overall, there had been 7157 total studies, though the research team only analyzed 11 of them. A significant finding of the team was that routine rapid viral testing was shown not to impact implementation of antibiotics (RR, 0.99; 95% CI, 0.93-1.05).

Despite this finding, testing was shown by the investigators to correlate with rises in influenza antiviral use (RR, 1.33; 95% CI, 1.02-1.75) and diminished chest radiography implementation (RR, 0.88; 95% CI, 0.79-0.98). It also correlated with blood tests (RR, 0.81; 95% CI, 0.69-0.97).

The research team did not identify a link with length of emergency department stay (0 hours; 95% CI, −0.17 to 0.16; moderate certainty), testing of patients’ urine (RR, 0.95; 95% CI, 0.77-1.17), return interrations (RR, 0.93; 95% CI, 0.79-1.08), or hospitalization (RR, 1.01; 95% CI, 0.95-1.08). The team added that 16% of patients were adults, and that viral testing did not impact antibiotic use across any pre-specified subgroup.

“Importantly, all studies were from high-income countries,” they wrote. “As antibiotic use is higher among marginalized communities within high-income countries and highest in middle-income countries, the effect of viral testing might have been different in other patient populations, limiting the generalizability.”

References

1. ^{Schober T, Wong K, DeLisle G, et al. Clinical Outcomes of Rapid Respiratory Virus Testing in Emergency Departments: A Systematic Review and Meta-Analysis. JAMA Intern Med. Published online March 04, 2024. doi:10.1001/jamainternmed.2024.0037.}
2. ^{Lee JJ, Verbakel JY, Goyder CR, et al. The clinical utility of point-of-care tests for influenza in ambulatory care: a systematic review and meta-analysis. Clin Infect Dis. 2019;69(1):24-33. doi:10.1093/cid/ciy837.}