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

Tilmann Schober; Kimberly Wong; Ga毛lle DeLisle; Chelsea Caya; Nathan J. Brendish; Tristan W. Clark; Nandini Dendukuri; Quynh Doan; Patricia S. Fontela; Genevieve C. Gore; Patricia Li; Allison J. McGeer; Kim Chloe No毛l; Joan L. Robinson; Eva Suarthana; Jesse Papenburg

doi:10.1001/jamainternmed.2024.0037

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March 4, 2024

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

罢颈濒尘补苍苍听厂肠丑辞产别谤,听惭顿^1,2; 碍颈尘产别谤濒测听奥辞苍驳,听惭顿^1,3; 骋补毛濒濒别听顿别尝颈蝉濒别,听惭厂肠笔贬^1,4; et al 颁丑别濒蝉别补听颁补测补,听惭厂肠笔贬³; Nathan J.听Brendish,听MBBS, PhD^5,6,7; Tristan W.听Clark,听MD^5,6,7; 狈补苍诲颈苍颈听顿别苍诲耻办耻谤颈,听笔丑顿³; Quynh听Doan,听MD, PhD⁸; Patricia S.听Fontela,听MD, PhD^1,3,9; Genevieve C.听Gore,听MLIS¹⁰; Patricia听Li,听MD, MSc^1,3,9; Allison J.听McGeer,听MD¹¹; Kim Chloe听No毛l,听MSc⁹; Joan L.听Robinson,听MD¹²; Eva听Suarthana,听MD, PhD^13,14; Jesse听Papenburg,听MD, MSc^1,3,9,15

Author Affiliations Article Information

¹Department of Pediatrics, McGill University, Montreal, Quebec, Canada
²Dr von Hauner Children鈥檚 Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
³Research Institute McGill University Health Centre, Montreal, Quebec, Canada
⁴Department of Pediatrics, Universit茅 de Montr茅al, Montreal, Quebec, Canada
⁵School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, England
⁶Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, England
⁷NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, England
⁸Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
⁹Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
¹⁰Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada
¹¹Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
¹²Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
¹³Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
¹⁴Health Technology Assessment Unit, McGill University Health Centre, Montreal, Quebec, Canada
¹⁵Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montreal, Quebec, Canada

JAMA Intern Med. 2024;184(5):528-536. doi:10.1001/jamainternmed.2024.0037

Key Points

Question听 Is rapid testing for respiratory viruses associated with patient treatment in the emergency department (ED)?

Findings听 In this systematic review and meta-analysis of 11 randomized clinical trials, rapid viral testing was not associated with reduced antibiotic use, ED length of stay, and the rate of ED return visits or of hospitalization. However, rapid viral testing was associated with moderately increased influenza antiviral use (absolute risk difference 1%) and decreased use of chest radiography and blood tests (absolute risk difference, 3%-4% each).

Meaning听 The results of this meta-analysis suggest that the benefits of ED rapid viral testing are limited for the general population.

Abstract

Importance听 Rapid tests for respiratory viruses, including multiplex panels, are increasingly available in emergency departments (EDs). Their association with patient outcomes remains unclear.

Objective听 To determine if ED rapid respiratory virus testing in patients with suspected acute respiratory infection (ARI) was associated with decreased antibiotic use, ancillary tests, ED length of stay, and ED return visits and hospitalization and increased influenza antiviral treatment.

Data Sources听 Ovid MEDLINE, Embase (Ovid), Scopus, and Web of Science from 1985 to November 14, 2022.

Study Selection听 Randomized clinical trials of patients of any age with ARI in an ED. The primary intervention was rapid viral testing.

Data Extraction and Synthesis听 Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines were followed. Two independent reviewers (T.S. and K.W.) extracted data and assessed risk of bias using the Cochrane Risk of Bias, version 2.0. Estimates were pooled using random-effects models. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations framework.

Main Outcomes and Measures听 Antibiotic use and secondary outcomes were pooled separately as risk ratios (RRs) and risk difference estimates with 95% CIs.

Results听 Of 7157 studies identified, 11 (0.2%; n鈥�=鈥�6068 patients) were included in pooled analyses. Routine rapid viral testing was not associated with 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 (RR, 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, 0.77-1.17; low certainty), ED length of stay (0 hours; 95% CI, 鈭�0.17 to 0.16; moderate certainty), return visits (RR, 0.93; 95%, CI 0.79-1.08; moderate certainty) or hospitalization (RR, 1.01; 95% CI, 0.95-1.08; high certainty). Adults represented 963 participants (16%). 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, or industry funding.

Conclusions and Relevance听 The results of this systematic review and meta-analysis suggest that there are 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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Clinical Outcomes of Rapid Respiratory Virus Testing in Emergency Departments: A Systematic Review and Meta-Analysis