BACKGROUND AND PURPOSE:

• Evidence is limited as to whether rapid viral (RV) testing for respiratory viruses in the emergency department (ED) will lead to decreased use of antibiotics
• Schober et al. (JAMA Internal Medicine, 2024) sought to determine if rapid respiratory virus testing in the ED for suspected acute respiratory infection (ARI) was associated with decreased antibiotic use

METHODS:

• Systematic review and meta-analysis
• Inclusion criteria
  • Randomized clinical trials
  • Studies of rapid viral testing on patients of any age with ARI in an ED
• Primary intervention
  • Availability of rapid respiratory virus testing (defined as the provision of test results during the patient’s ED stay) or
  • Awareness of the treating physician of the rapid test results
• Study design
  • Risk of bias was assessed
  • Quality of evidence was assessed with GRADE criteria
• Primary outcome
  • Antibiotic use
• Secondary outcomes
  • Ancillary tests | ED length of stay | ED return visits and hospitalization | Increased influenza antiviral treatment

RESULTS:

• 11 studies | 6068 patients
  • Adults: 16%
• Routine rapid viral testing was not associated with antibiotic use
  • Risk ratio (RR) 0.99 (95% CI, 0.93 to 1.05) | High certainty
• However, rapid testing was associated with
  • Higher use of influenza antivirals
    • RR 1.33 (95% CI, 1.02 to 1.75) | Moderate certainty
  • Lower use of chest radiography
    • RR 0.88 (95% CI, 0.79 to 0.98) | Moderate certainty
  • Lower use of blood tests
    • RR 0.81 (95% CI, 0.69 to 0.97) | Moderate certainty
• There was no link between rapid testing and
  • Urine testing
    • RR 0.95 (95% CI, 0.77 to 1.17) | Low certainty
  • ED length of stay
    • MD 0 hours (95% CI, −0.17 to 0.16 | Moderate certainty
  • Return visits
    • RR 0.93 (95%, CI 0.79 to 1.08) | Moderate certainty
  • Hospitalization
    • RR 1.01 (95% CI, 0.95 to 1.08) | High certainty
• There was no association of viral testing with antibiotic use in any prespecified subgroup by
  • Age | Test method | Publication date | Number of viral targets | Risk of bias | Industry funding

CONCLUSION:

• There is limited benefits to routine viral testing among individuals presenting in the ED with an ARI
• Antivirals are recommended for more severe disease
• Fewer patients with a positive RV test result were prescribed antibiotics, counterbalanced by more prescribing for patients with a negative result
• Further study should be conducted in adults, especially those with high-risk conditions
• The authors state

Fewer patients with a positive RV test result were prescribed antibiotics, counterbalanced by more prescribing for patients with a negative result

Evidence suggests that RV testing in the ED should be reserved for patients for whom results will change treatment. Further RCTs in adults and high-risk populations are warranted

Learn More – Primary Sources:

Clinical Outcomes of Rapid Respiratory Virus Testing in Emergency Departments: A Systematic Review and Meta-Analysis