Table 4.
Overview of Clinical Outcomes Presented in Included Clinical Impact Studies (n = 15)
| Outcome per study (author, year, country) | Study design | Sample size (n) | Effect - intervention vs control/ odds ratio (OR) | P-value | Conclusion |
|---|---|---|---|---|---|
| Antibiotic prescriptions | |||||
| Brendish, 2017 (UK) |
RCT (1:1) | 714 | 84% vs 83% | .84 | No decrease in antibiotic prescriptions |
| Andrews, 2017 (UK) |
RCT (quasia) | 522b | 75% vs 77% | .99 | |
| Chu, 2015 (USA) |
Before-after, multivariatec | 350 | 63% vs 76% | <.001 | |
| Rogers, 2014 (USA) |
Before-after, univariate | 1136 | 72% vs 73% | .61 | |
| Rappo, 2016 (USA) |
Before-after, univariate | 337d | 66% vs 61% | .35 | |
| Linehan, 2017 (Ireland) |
Before-after, univariate | 67e | 33% vs 76% | <.001 | |
| Busson, 2017 (Belgium) |
Cohort, no control group | 69 | In 36.2% of patients antibiotic prescriptions were avoided | - | |
| Keske, 2017 (Turkey) | Cohort, no control group | 359d | 45% of virus positive patients received antibiotics | - | |
| Duration of antibiotic therapy | |||||
| Branche, 2015 (USA) |
RCT (1:1) | 300 | Median 3 days [IQR 1–7] vs 4 [0–8] | .71 | No decrease in duration of antibiotic therapy |
| Brendish, 2017 (UK) |
RCT (1:1) | 714 | Mean 7.2 days [SD 5.1] vs 7.7 [4.9] | .32 | |
| Andrews, 2017 (UK) |
RCT (quasia) | 522b | Median 6 days [IQR 4–7] vs 6 [5–7.3] | .23 | |
| Gilbert, 2016 (USA) |
RCT (quasif) | 127 | Mean 1053/1000 patient-days [SD 657] vs 472/1000 [1667] | .07 | |
| Gelfer, 2015 (USA) |
RCT (quasif) | 18d | Mean 683/1000 patient-days [SD 317] vs 917/1000 [220] | .052 | |
| Rogers, 2014 (USA) |
Before-after, univariate | 1136 | Mean 2.8 days [SD 1.6] vs 3.2 [SD 1.6] | .003 | |
| Rappo, 2016 (USA) |
Before-after, univariate | 212e | Median 1 vs 2 days | .24 | |
| Keske, 2017 (Turkey) | Cohort, no control group | 160d | Mean 6.5 days [SD 3.7] in virus positive patients | - | |
| Oseltamivir prescriptions | |||||
| Brendish, 2017 (UK) |
RCT (1:1) | 714 | 18% vs 14% | .16 | More appropriate oseltamivir use in influenza positive patients |
| 94e | 91% vs 65% | .003 | |||
| Chu, 2015 (USA) |
Before-after, univariate | 350 | 55% vs 45% | .05 | |
| 40e | 100% vs 100% | 1.00 | |||
| 136g | 45% vs 43% | .60 | |||
| Rappo, 2016 (USA) |
Before-after, univariate | 212e | 61% vs 61% | .96 | |
| Linehan, 2017 (Ireland) |
Before-after, univariate | 68e | 95% vs 72% | <.01 | |
| Xu, 2013 (USA) |
Cohort, no control group | 97e | 81% of influenza positive patients received oseltamivir | - | |
| Length of hospital stay | |||||
| Branche, 2015 (USA) |
RCT (1:1) | 300 | Median 4 vs 4 days | NS | Reduction in length of hospital stay |
| Brendish, 2017 (UK) |
RCT (1:1) | 714 | Mean 5.7 days [SD 6.3] vs 6.8 [7.7]h | .044 | |
| Andrews, 2017 (UK) |
RCT (quasia) | 545 | Median 4.1 days [IQR 2.0–9.1] vs 3.3 [1.7–7.9] | .28 | |
| Rappo, 2016 (USA) |
Before-after, multivariatei | 212e | Median 1.6 days [IQR 0.3–4.8] vs 2.1 [0.4–5.6] | .040 | |
| Rogers, 2014 (USA) |
Before-after, univariate | 1136 | Mean 3.2 days [SD 1.6] vs 3.4 [1.7] | .16 | |
| Chu, 2015 (USA) |
Before-after, univariate | 350 | Median 4 days [range 1–164] vs 5 [0–117] | .33 | |
| Timbrook, 2015 (USA) |
Cohort, no control group | 601d | Median 1 day [IQR 0–3] in virus positive patients | - | |
| Hospital admissions | |||||
| Brendish, 2017 (UK) |
RCT (1:1) | 714 | 92% vs 92% | .94 | No reduction in hospital admissions |
| Rappo, 2016 (USA) |
Before-after, univariate | 337d | 76% vs 74% | .60 | |
| Linehan, 2017 (Ireland) |
Before-after, univariate | 69e | 45% vs 88% | <.001 | |
| Busson, 2017 (Belgium) |
Cohort, no control group | 69 | 5.8% of hospitalizations was avoided | - | |
| Safety | |||||
| Branche, 2015 (USA) |
RCT (1:1) | 300 | No difference in-hospital deaths, SAEs, new pneumonia cases or 90-day post-hospitalization visits | NS | Safety is not affected |
| Brendish, 2017 (UK) |
RCT (1:1) | 714 | 30-day readmission 13% vs 16% | .28 | |
| 30-day mortality 3% vs 5% | .15 | ||||
| ICU admission 3% vs 2% | .36 | ||||
| Andrews, 2017 (UK) |
RCT (quasia) | 545 | 30-day readmission 19% vs 20% | .70 | |
| 30-day mortality 4% vs 4% | .79 | ||||
| Rogers, 2014 (USA) |
Before-after, univariate | 1136 | Mortality 0% vs 0% | 1.00 | |
| ICU admission 0% vs 0% | 1.00 | ||||
| Chu, 2015 (USA) |
Before-after, univariate | 350 | Mortality 2% vs 4% | .68 | |
| ICU admission 31% vs 25% | .19 | ||||
| Timbrook, 2015 (USA) |
Cohort, no control group | 601d | ICU admission in 8.8% of virus positive patients | - | |
| (1) Costs; (2a) no. of / (2b) any additional chest radiographs; (3a) use of / (3b) time in isolation facilities | |||||
| Gilbert, 2016 (USA) |
RCT (quasif) | 127 | (1) $8308/1000 patient-days [SD 10165] vs $11890/1000 [11712] | .02 | Potential reduction in costs and additional X-rays |
| Rappo, 2016 (USA) |
Before-after, multivariatei | 188e | (2a) Median 1 [IQR 1-1] vs 1 [1–2] | .005 | |
| Busson, 2017 (Belgium) |
Cohort, no control group | 28e | (2b) 25% reduction of X-rays in influenza positive patients | - | |
| Brendish, 2017 (UK) |
RCT (1:1) | 385j |
(3a) 33% vs 25% | .12 | |
| 50e | 74% vs 57% | .24 | |||
| Rogers, 2014 (USA) |
Before-after, univariate | 1136 | (3b) 2.9 days [SD 1.6] vs 3.0 [1.7] | .27 | |
| Muller, 2016 (Canada) |
Before-after, univariate | 125 | (3b) Droplet isolation: 3.5 days vs 6.0 | <.001 | |
| Turnaround time | |||||
| Brendish, 2017 (UK) |
RCT (1:1) | 714 | Mean 2.3 hours [SD 1.4] vs 37.1 [21.5] | <.001 | Significantly faster |
| Andrews, 2017 (UK) |
RCT (quasia) | 545 | Median 19 hours [IQR 8.1–31.7] vs 39.5 [25.4–57.6]k | <.001 | |
| Gilbert, 2016 (USA) |
RCT (quasif) | 127 | Mean 2.1 hours [SD 0.7] vs 26.5 [15] | <.001 | |
| Gelfer, 2015 (USA) |
RCT (quasif) | 59 | Mean 1.8 hours [SD 0.3] vs 26.7 [16] | <.001 | |
| Chu, 2015 (USA) |
Before-after, multivariatec | 350 | Median 1.7 hours [range 0.8–11.4] vs 25.2 [2.7–55.9] | <.001 | |
| Rogers, 2014 (USA) |
Before-after, univariate | 1136 | Mean 6.4 hours [SD 4.9] vs 18.7 [8.2]l | <.001 | |
| Pettit, 2015 (USA) |
Before-after, univariate | 1102 | Mean 3.1 hours vs 46.4 | <.001 | |
| Rappo, 2016 (USA) |
Before-after, univariate | 212e | Median 1.7 hours [IQR 1.6–2.2] vs 7.7 [0.8–14] | .015 | |
| Muller, 2016 (Canada) |
Before-after, univariate | 125 | Mean 3.6 hours vs 35.0 | - | |
| Xu, 2013 (USA) |
Cohort, no control group | 2537 | Median 1.4 hours | - |
Abbreviations: ED, emergency department; ICU, intensive care unit; IQR, interquartile range; NS, not significant; PCR, polymerase chain reaction; RCT, randomized controlled trial; SAE, serious adverse event; SD, standard deviation.
aQuasi randomized randomization process with rapid viral molecular testing on even days of the month and reference laboratory PCR testing on odd days.
bAnalysis for antibiotic prescription performed in 522/545 patients due to missing data on antibiotic prescriptions for 13 patients in control arm and ten in intervention arm.
cMultivariate analysis adjusting for confounders age, location of sample collection, receipt of influenza vaccine, immunosuppressed status and pregnancy.
dSubgroup analysis in virus positive patients. In the study of Gelfer (2015) among these virus positive patients only the patients who received antimicrobials were included. In the study of Keske (2017) these virus positive patients included only inpatients, and for the duration of antibiotic therapy only patients with inappropriate antibiotic use were included.
eSubgroup analysis in influenza positive patients. In the study of Busson (2017) among these influenza positive patients only the patients who were tested with rapid molecular tests during working hours and who were still in the ED during the test result were included. In the study of Rappo (2016) among these influenza positive patients only the patients who received a chest radiograph were included in the multivariate analysis for the number of chest radiographs.
fQuasi randomized randomization process with rapid viral molecular testing during one-week and reference laboratory PCR testing during the following week and so on.
gSubgroup analysis in influenza negative patients.
hAdjusted for in-hospital mortality.
iMultivariate analysis adjusting for confounders age, immunosuppressed status, asthma and admission to ICU.
jAnalysis for isolation facility use were only available from patients included during the second season of inclusion.
kIn the study of Andrews (2017) patients were admitted to an Acute Medical Unit of Medical Assessment Centre before inclusion in the study. The turnaround time was calculated as the time from admission to result and therefore also covers the time from admission until the swab was actually taken (during which time the assessment of eligibility for inclusion and informed consent procedure were performed).
lIn the study of Rogers (2014) patients were included at the Emergency Department, but also after admission, leading to a longer time to result.