There is little evidence for or against implementation in primary care.
- Dr Joseph Lee, NIHR In-Practice Fellow, University of Oxford.
Point-of-care tests for influenza have no effect on admissions, return visits, or antibiotic prescribing but were associated with increased antiviral prescribing, finds a meta-analysis of 13 studies published in Clinical Infectious Diseases.
UK guidance from the National Institute for Health and Care Excellence (NICE) recommends no antibiotic prescribing for patients with respiratory tract infections such as influenza, unless they are systemically unwell or deemed ‘high-risk’, yet up to 40% of patients with influenza are prescribed antibiotics due to diagnostic uncertainty.
Funded by the NIHR Community Health Care MedTech and In Vitro Diagnostics Cooperative, Oxford University researchers sought to understand whether diagnostics could improve antimicrobial stewardship by looking at direct evidence of clinical outcomes. Their review includes seven randomised and six non-randomised studies involving more than 9,000 patients, with most evidence coming from paediatric emergency departments.
The researchers found that in randomised trials, point-of-care tests for influenza had no effect on admissions, returning for care, or antibiotic prescribing, but they were tied to an increase in prescribing of antivirals. In addition, further testing was reduced for full blood counts, blood cultures, and chest x-ray but not for urinalysis. Tests also had no effect on time spent in the emergency department. Fewer non-randomised studies reported these outcomes, with some findings reversed or lessened.
Lead researcher, Dr Joseph Lee, an Oxfordshire-based GP and NIHR In-Practice Fellow in the Nuffield Department of Primary Care Health Sciences, said: "Point-of-care testing for influenza influences prescribing and testing decisions, particularly for children in emergency departments, yet there is little evidence for or against implementation in primary care. While large, well-conducted observational studies are needed, clinicians should consider local practice before they utilise these tests since they are not a substitute for clinical assessment.”
Dr Philip Turner, MIC Manager and Senior Researcher said: “Understanding the broader impact of point-of-care diagnostic tests on clinical pathways is a key focus area for the MIC and is an area which has been historically underrepresented in the clinical evidence base. This synthesis contributes to the aims of our Precision Antimicrobial Prescribing clinical theme, providing a better understanding of the impact of diagnostic tests on the pathway associated with this common presentation including the prescription of antimicrobials.”
The clinical utility of point-of-care tests for influenza in ambulatory care: A systematic review and meta-analysis.
Lee JL, Verbakel JY, Goyder CR, Ananthakumar T, Tan PS, Turner PJ, Hayward G, Van den Bruel A. Clinical Infectious Diseases 2018 ciy837 https://doi.org/10.1093/cid/ciy837