Table 2.
Clinical studies evaluating clinical impact of RDT use in ED
| Syndrome or disease | Approach and targeted pathogens | Test brand | Population (n) | Study design | Findings | Reference |
|---|---|---|---|---|---|---|
| Upper Respiratory tract infections |
Group A Streptococcus RADT | QuickVue (Quidel) | Infants (223) | SSPS | After using RADT, antibiotic prescriptions decreased by 42.6% | [40] |
| Group A Streptococcus PCR | cobas Liat Strep A (Roche) | Infants (275) | SSPS | Compared with RADT, POC PCR resulted in significantly greater appropriate antibiotic use (97.1% vs. 87.5%; p 0.0065) | [6] | |
| Lower Respiratory tract infections | mPCR in ED vs. usual tests in central laboratory | FilmArray (BioFire, bioMérieux) | Infants (1136) | Single-centre retrospective | mPCR in ED decreases the duration of antibiotic use (from 3.2 to 2.8 days p 0.003), the length of inpatient stay (from 3.4 to 3.2 days p 0.03). | [41] |
| mPCR in ED vs. usual tests in central laboratory | FilmArray (BioFire, bioMérieux) | Adults (720) | SSPS | mPCR in ED decreases the duration of antibiotic use (from 6.5 to 2.9 days, p 0.0009), the hospital length of stay (from 6.8 to 5.7 days, p 0.004) | [42] | |
| mPCR in ED vs. usual tests in central laboratory | FilmArray (BioFire, bioMérieux) | Adults (606) | SSPS | No association between respiratory PCR POC testing and length of stay but a reduction in the median time to the first dose of antiviral (from 60.4 to 24h) and appropriate treatment of mycoplasma infection | [43] | |
| Influenza PCR | cobas Liat (Roche) | Adults (620) | Multicentre retrospective | Antivirals were prescribed more often in patients that tested positive by Liat PCR (82.4%) than in those testing positive by either RIDT or reflex PCR (69.9%; P < 0.05) | [44] | |
| Influenza PCR | FilmArray (BioFire, bioMérieux) | Adults (337) | Single-centre retrospective | Diagnosis of influenza by FilmArray was associated with significantly lower ORs for admission (p 0.046), length of stay (p 0.040), duration of antimicrobial use (p 0.032), and number of chest radiographs (p 0.005). | [45] | |
| Influenza RADT | QuickVue (InGen) | Infants (170) | SSPS | Positive RADT enabled a significant decrease in orders for chest x-rays (64.4% vs. 45.8%, p <0.05) and laboratory tests (71.1% vs. 41.1%, p <0.05). | [46] | |
| Influenza immunoassay | Binax NOW (Alere) | Adults + infants (827) | Multicentre prospective | For a cohort of 1000 participants, annual estimated nondiagnostic cost savings with Alere are £215040. | [47] | |
| Pneumococcus (SP) and legionella (LP) urinary antigen | Binax NOW (Alere) | Adults (1941) | Epic study multicentre prospective | IDSA/ATS indications had 61% sensitivity (95% CI 49–71) and 39% specificity (95% CI 37–41) for SP, and 63% sensitivity (95% CI 44–79) and 35% specificity (95% CI 33–37) for LP. | [48] | |
| Pneumococcus (SP) and legionella (LP) urinary antigen | Binax NOW (Alere) | Adults (1224) | Single-centre retrospective | Only 7 tests led to appropriate antimicrobial modification, and since 972 tests had no impact, we estimate that potential cost savings, if the test had not been used, would have been 26,244 € during a 3 year period, that is 8748 € per year. | [49] | |
| Gastrointestinal infections | GI PCR panel | FilmArray (BioFire, bioMérieux) | Adults + infants (9402) | Cross sectional retrospective | Patients who received a GI panel were less likely to undergo any endoscopic procedure (8.4% GI panel vs. 9.6% stool culture, p 0.008) or any abdominal radiology (29.4% GI panel vs. 31.7%, p 0.002). Within 14 days after stool testing, patients who received a GI panel were less likely to be prescribed any antibiotic (36.2% GI panel vs. 40.9%, p <0.001). | [50] |
| GI PCR panel | FilmArray (BioFire, bioMérieux) | Adults + infants (241) | Single-centre retrospective | The GI panel helped decrease the need for other diagnostic tests, reducing unnecessary use of antibiotics and leading to a reduction in hospital length of stay. | [51] | |
| Central nervous system infections | Meningitis and encephalitis | FilmArray (BioFire, bioMérieux) | Infants (145) | Multicentre prospective | FilmArray ME panel results may conduct in a decreased length of stay and in less antimicrobial exposure for infants with low-risk viral infection detected. | [52] |
| Malaria | Malaria testing | Illumigene Malaria (Meridian Bioscience) | Adults (298) | Multicentre retrospective and prospective | A cost-benefit analysis suggests savings of up to USD$13 per specimen using a novel algorithm with this test. | [32] |
| Genital and sexually transmitted infections | HIV RNA testing (PCR) | Xpert (Cepheid) | Adults (706) | SSPS | The addition of Xpert HIV-1 Qual testing led to an increase in confirmed diagnoses by 25% (from 24 to 30 cases). | [53] |
| Chlamydia trachomatis and Neisseria gonorrhoeae testing (PCR) | Xpert (Cepheid) | Adults (70) | Single-centre RCT | The use of Xpert CT/NG reduced overtreatment and improved adherence. | [54] | |
| C. trachomatis and N. gonorrhoeae testing (PCR) | Xpert (Cepheid) | Women (254) | Single-centre RCT | Xpert CT/NG reduced overtreatment and improved undertreatment of patients tested in ED. | [55] |
CI, confidence interval; ED, emergency department; GI, gastrointestinal; IDSA/ATS, Infectious Diseases Society of America/American Thoracic Society; LP, Legionella pneumophila; mPCR, multiplex PCR; OR, odds ratio; POC, point of care; RADT, rapid antigen detection test; RCT, randomized controlled trial; SP, Streptococcus pneumoniae; SSPS, single-centre prospective study.