Table 2.
Included studies assessing antibiotic prescriptiona
| Authors, Year, Location | Population, Study Period, Patient Groups | POCT | Results |
|---|---|---|---|
| Andrews et al, 2017,40 UK | Quasi‐randomised study assessing 606 adults (>16 y) at a single NHS centre over one influenza season, Jan‐July 2015. Standard testing used on odd days (n = 211), POCT used on even days (n = 334). | FilmArray Respiratory Panel | Not significant, POCT+ vs standard+ on decision to stop, remain off or reduce AB: 35.8% vs 32%, P < 0.05 |
| Brendish et al, 2017,16 UKb | An RCT enrolling 720 adults (>18 y) with acute respiratory illness at a large UK hospital during Jan‐July 2015, and Oct 2015 to April 2016. Patients randomly assigned either POCT (n = 362) or routine care (n = 358). | FilmArray Respiratory Panel | Not significant, POCT+ vs standard+: 301/360 (84%) vs 294/354 (83%), P = 0.96 |
| Nitsch‐Osuch et al, 2017,17 Polandb | A study comparing treatment of hospitalised children in a paediatric ward during two consecutive influenza seasons: Jan‐Mar 2015, when no RIDT were in use (n = 52), and Jan‐Mar 2016, when RIDT were implemented into routine practice (n = 63). | bioNexia Influenza A+B | Significant, POCT+ vs standard+: 7/11 (64%) vs 14/15 (93%), P < 0.05 |
| Trabattoni et al, 2017,24 Franceb , c | A single centre prospective observational study comparing two diagnostic strategies over 2 months. During Feb 2016 standard laboratory testing was used for diagnosis of influenza (n = 169), and in Mar 2016, a POCT was performed (n = 132). | Alere i Influenza A&B | Not significant, POCT vs standard: 39/132 (29.5%) vs 60/169 (35.5%), P = 0.32 |
| Jun et al, 2016,33 Koreac | A retrospective study conducted in the ED of a Korean university hospital over two influenza periods: Dec 2008 to Jan 2009, and Feb‐Mar 2013. Consisted of 342 paediatric patients (146 in period 1 and 196 in period 2), and 132 adult patients (61, period 1; 71, period 2). | Not specified | Significant, POCT+ vs POCT−: 3/17 (17.6%) vs 31/54 (57.4%), P < 0.05 |
| Li‐Kim‐Moy et al, 2016,18 Australiab , c | A retrospective review of 364 lab‐confirmed influenza cases presenting at a paediatric ED during Jan‐Dec 2009. Children (<18 y) were diagnosed with influenza by either POCT (n = 236) or standard testing (n = 65). | QuikVue Inluenza A+B | Significant, POCT+ vs standard+: 78/236 (33.1%) vs 35/65 (53.8%), P = 0.003 |
| Berthod et al, 2015,42 Switzerland | An RCT of adult patients presenting with ILI to two Swiss hospitals within 14 d of returning from a trip abroad. The study ran over a 4‐y period (Dec 2008 to Nov 2012), and patients randomly received either a POCT (n = 60) or standard care (n = 33) following a nasopharyngeal swap that was taken for laboratory confirmation. | Directigen Flu A+B rapid test | Not significant, POCT vs standard: 14/60 (23%) vs 13/33 (39%), P = 0.15 |
| Chu et al, 2015,30 USAb | A retrospective study of 350 adult (>18 y) patients at a teaching hospital and medical centre in the US over two influenza seasons, Feb–Mar 2012 and January 2013. The first season was prior to implementation of POCT (n = 175), and in the second season, POCT was used systematically (n = 175). | Simplexa Flu A/B & RSV Kit | Significant, pre‐POCT vs post‐POCT: 133/175 (76%) vs 110/175 (63%), P = 0.008 |
| González‐Del Vecchio 2015,39 Spainb | Cohort of 217 child and adult influenza positive from a general teaching hospital in Spain over one influenza season, Jan‐Mar 2014. Patients were divided into A‐POCT negative, reference positive (n = 132) or B‐POCT positive (n = 85) | Xpect Flu A&B | Significant, A vs B: 118/132 (89.3%) vs 57/85 (67.0%), P < 0.01 |
| Lacroix et al, 2015,34 France | A prospective study of febrile children (<5 y) presenting to a paediatric ED in France during a single influenza season. 170 subjects were included in the Jan‐Mar 2013 period, all of whom received diagnosis by POCT. | Quikvue influenza A+B | Significant, POCT+ vs POCT−: 4/80 (5%) vs 33/90 (36.6%), P < 0.05 |
| Tillekeratne et al, 2015,29 Sri Lanka | A prospective two phase study in the outpatient department of a Sri Lankan hospital. During the first phase (Mar‐Dec 2013), patients were attended by physicians who were not aware of their POCT results (n = 316). During the second phase (Jan‐Oct 2014), patients were attended by physicians who were made aware of POCT results (n = 241). | Veritor Flu A+B | Significant, IF positive patients phase 1 vs phase 2: 123/147 (83.7%) vs 43/69 (62.3%), P = 0.001 |
| Blaschke et al, 2014,19 USAb , d | A retrospective study using data from the National Hospital Ambulatory Medical Care Survey over three influenza periods: Jan‐Apr 2007, Oct‐Dec 2008, and Jan Apr 2009. 1166 of an estimated 4.9 M eligible ED visits were sampled and examined in three groups: POCT+, POCT−, and Influenza (+) by standard test. | Not specified | Significant, POCT+ vs standard+: 11% vs 23%, P = 0.05 significant, POCT+ vs POCT−: 11% vs 47%, P < 0.0001 |
| Jeong et al, 2014,27 Koreac | A retrospective review of data from 437 patients who were suffering from ILI and were discharged from the ED of a Korean hospital over two influenza seasons. In 2010‐2011 patients received standard care (n = 221), and in 2011‐2012, patients were diagnosed by POCT (n = 216). | Alere SD Bioline Influenza | Significant, POCT vs standard: 54/216 (25.0%) vs 97/221 (43.9%), P < 0.01significant, POCT+ vs POCT−: 7/73 (9.6%) vs 42/123 34.1%, P < 0.01 |
| Lim et al, 2014,23 Koreab | A retrospective review of medical records of 770 children (<15 y) hospitalised with laboratory confirmed influenza between Feb 2004 and June 2007. Different treatment groups were analysed and included patients receiving; oseltamivir only (n = 27), antibiotics only (n = 620), antibiotics/oseltamivir combination (n = 67), or standard supportive care (n = 56). | Directigen EZ Flu A + B | Significant, oseltamivir only vs antibiotics only, antibiotics/oseltamivir combination, standard supportive care: likelihood of diagnosis by POCT− 22/27 (81.5%) vs 21/620 (3.4%) P < 0.001, 37/67 (55.2%) P = 0.017, 9/56 (16.1%) P < 0.001 |
| Nitsch‐Osuch et al, 2013,26 Poland | A prospective cohort study conducted in three Warsaw primary care clinics over two influenza seasons of 2009/2010 and 2010/2011.256 children with ILI aged 0‐5 y were given either a POCT (n = 115), or standard care (n = 141). | Directigen EZ Flu A+B | Significant, POCT vs standard: 7% vs 16%, P = 0.032 |
| Theocharis et al, 2010,22 Greeceb | An observational study of patients with ILI who received house call visits from a network of doctors in Greece during Jan‐May 2009. 3412 visits were due to ILI, 184 of which had data available from a POCT. | Influ A&B Uni‐Strip Dry Swabs (C‐1512) | Significant, POCT+ vs POCT−: 4/97 (4.1%) vs 32/87 (36.8%), P < 0.01 |
| Jennings et al, 2009,20 Germanyb | A study analysing data from a standardised questionnaire that was used by paediatricians in Germany assessing children 1‐12 y with ILI. During the study period Jan‐April 2007, 16 907 patients were evaluated, 15 871 of which received a POCT. | Clearview Exact Influenza A+B | Significant, POCT+ vs standard+: 271/7658 (3.5%) vs 125/725 (17.2%) |
| Ozkaya et al, 2009,28 Turkey | A cross‐sectional, single blinded trial of children aged 3‐14 who presented to the ED of a Turkish paediatric hospital between November 2006 and Mar 2007. Patients were allocated into two groups that received either a POCT or a standard physical examination. | Influenza A/B Rapid Test | Significant, POCT vs standard: 32% vs 100%, P < 0.0001 |
| D'Heilly et al, June 2008,38 USA | Retrospective study of 311 adults patients at a medical centre in USA over two influenza seasons; Nov 2003 to May 2004 and Oct 2004 to May 2005. Compared positive (n = 78) and negative (n = 233) POCT results. | FLU OIA A/B | Significant, POCT+ vs POCT−: AB odds ratio = 0.20 (95% CI, 0.10‐0.42) |
| Falsey et al, 2007,37 USAb | Retrospective analysis of 166 adult (>18 y) hospitalised patients at a hospital in USA over four influenza seasons, Nov‐Apr 1999‐2003. Comparison of POCT positive (n = 86) and POCT negative/no POCT (n = 80) | Directigen | Significant, POCT+ vs POCT−/no test: 74/86 (86%) vs 79/80 (98.8%), P = 0.002 |
| Bhavnani et al, 2006,36 Thailand | A retrospective analysis of medical records from 300 patients of all ages selected from 5 outpatient departments in Thailand. Records were selected at a 1:2 ratio of ILI cases that were diagnosed as influenza positive (n = 106) or negative (n = 194) by POCT. | Quikvue influenza test | Significant, POCT+ vs POCT−: 77/106 (73%) vs 168/194 (87%), P = 0.003 |
| Benito‐Fernandez et al, 2006,35 Spainc | A prospective study of febrile infants (<36 months) presenting to a single paediatric ED in Spain. 206 patients received diagnosis by POCT, with no conformational laboratory testing performed. | Directigen Flu A+B Test Kit | Significant, POCT+ vs POCT−: 0/84 (0%) vs 47/122 (38.5%), P < 0.01 |
| Poehling et al, 2006,25 USAb | An RCT enrolling children <5 y presenting with ILI in a Tennessee county over two consecutive influenza seasons (2003‐2004). All subjects (n = 468) had a nasal and throat swab obtained for PCR, and surveillance days were randomised to perform POCT (n = 205). | Quikvue influenza® test | Not significant, POCT vs standard: 61/205 (29.8%) vs 75/263 (28.5%) |
| Iyer et al,41 2006, USAc | A prospective, quasi‐randomised controlled trial of febrile children aged 2‐24 months during two influenza periods. Diagnosis was determined by either POCT (n = 345) or standard test (n = 355), which was determined by alternating testing days. | Quikvue influenza test | Not significant, POCT vs standard: 54/345 (15.7%) vs 59/355 (16.6%) |
| Bonner et al, 2003,31 USAb | An RCT of patients aged 2 mo to 21 y at a children's teaching hospital ED in USA over one influenza season, Jan‐Mar 2002. All patients (n = 391) received a POCT. Of 202 influenza positive patients the physician was either made aware of the result (n = 96), or was unaware (n = 106). | Flu OIA | Significant, aware vs unaware: 7/96 (7.3%) vs 26/106 (24.5%), P < 0.001 |
| Esposito et al, 2003,32 Italy | An RCT of 957 paediatric (<15 y) patients at the ED of a teaching hospital in Italy over one influenza season, Jan‐Feb 2002. Patients were randomly allocated POCT/no POCT, and outcomes for POCT positive (n = 43), POCT negative (n = 435), and standard care (n = 479) were compared. | Quickvue Influenza Test | Significant, POCT+ vs POCT−, standard care: AB (%) 32.6 vs 64.8 (P < 0.0001), vs 61.8 (P = 0.0003) |
Abbreviations: ED, emergency department; POCT, point of care tests; RCT, randomised controlled trial.
a
Listed by year of publication, alphabetical.
b
Also assessed antiviral prescription (Table 1).
c
Also assessed ED length of stay (Table 3).
d
Reported as weighted percentages, exact numbers unavailable.