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Euro Surveill . The experience of point-of-care testing for influenza in Scotland in 2017/18 and 2018/19 - no gain without pain

tetano

tetano

Editor, Senior Moderator
Euro Surveill


. 2020 Nov;25(44).
doi: 10.2807/1560-7917.ES.2020.25.44.1900419.
The experience of point-of-care testing for influenza in Scotland in 2017/18 and 2018/19 - no gain without pain


Elizabeth M Dickson[SUP] 1 2 [/SUP], Diogo Fp Marques[SUP] 1 [/SUP], Sandra Currie[SUP] 1 [/SUP], Annette Little[SUP] 1 [/SUP], Kirsty Mangin[SUP] 1 [/SUP], Michael Coyne[SUP] 1 [/SUP], Arlene Reynolds[SUP] 1 [/SUP], Jim McMenamin[SUP] 1 [/SUP], David Yirrell[SUP] 3 1 [/SUP]



Affiliations

Abstract

BackgroundDuring the 2017/18 and 2018/19 influenza seasons, molecular amplification-based point-of-care tests (mPOCT) were introduced in Scotland to aid triaging respiratory patients for hospital admission, yet communication of results to national surveillance was unaccounted for.AimThis retrospective study aims to describe steps taken to capture mPOCT data and assess impact on influenza surveillance.MethodsQuestionnaires determined mPOCT usage in 2017/18 and 2018/19. Searches of the Electronic Communication of Surveillance in Scotland (ECOSS) database were performed and compared with information stored in laboratory information management systems. Effect of incomplete data on surveillance was determined by comparing routine against enhanced data and assessing changes in influenza activity levels determined by the moving epidemic method.ResultsThe number of areas employing mPOCT increased over the two seasons (6/14 in 2017/18 and 8/14 in 2018/19). Analysis of a small number of areas (n = 3) showed capture of positive mPOCT results in ECOSS improved between seasons and remained high (> 94%). However, capture of negative results was incomplete. Despite small discrepancies in weekly activity assessments, routine data were able to identify trend, start, peak and end of both influenza seasons.ConclusionThis study has shown an improvement in capture of data from influenza mPOCT and has highlighted issues that need to be addressed for results to be accurately captured in national surveillance. With the clear benefit to patient management we suggest careful consideration should be given to the connectivity aspects of the technology in order to ensure minimal impact on national surveillance.

Keywords: Influenza; national surveillance; patient management; point-of-care testing.
 
Euro Surveill


. 2020 Nov;25(44).
doi: 10.2807/1560-7917.ES.2020.25.44.1900430.
Point-of-care tests for influenza A and B viruses and RSV in emergency departments - indications, impact on patient management and possible gains by syndromic respiratory testing, Capital Region, Denmark, 2018


Uffe Vest Schneider[SUP] 1 [/SUP], Mona Katrine Alberthe Holm[SUP] 1 [/SUP], Didi Bang[SUP] 2 [/SUP], Randi F?ns Petersen[SUP] 2 [/SUP], Shila Mortensen[SUP] 2 [/SUP], Ramona Trebbien[SUP] 2 [/SUP], Jan Gorm Lisby[SUP] 1 [/SUP]



Affiliations

Abstract

BackgroundPoint-of-care tests (POCT) for influenza A and B viruses and respiratory syncytial virus (RSV) were implemented in emergency departments of all hospitals in the Capital Region of Denmark in 2018.AimTo establish whether POC testing for influenza viruses or RSV is based on a valid respiratory symptom indication, whether changes in patient management based on a positive result are safe and whether syndromic POC testing may benefit patients with influenza or RSV.MethodsSamples from 180 children (< 18 years) and 375 adults tested using POCT between February and July 2018 were retested for 26 respiratory pathogens. Diagnosis, indication for POC testing, hospitalisation time, antimicrobial therapy and readmission or death within one month of testing were obtained from patient records.ResultsA valid indication for POC testing was established in 168 (93.3%) of children and 334 (89.1%) of adults. A positive POCT result significantly reduced antibiotic prescription and median hospitalisation time by 44.3 hours for adults and 14.2 hours for children, and significantly increased antiviral treatment in adults. Risk of readmission or death was not significantly altered by a positive result. Testing for 26 respiratory pathogens established that risk of coinfection is lower with increasing age and that POCT for adults should be restricted to the influenza and RSV season.ConclusionPositive POCT resulted in changed patient management for both children and adults, and was deemed safe. POCT for additional pathogens may be beneficial in children below 5 years of age and outside the influenza and RSV season.

Keywords: FilmArray; Roche cobas Liat system; bedside testing; indication; influenza A and B viruses and RSV; near patient testing; patient management; point-of-care; syndromic testing.
 
Euro Surveill


. 2020 Nov;25(44).
doi: 10.2807/1560-7917.ES.2020.25.44.1900420.
Do point-of-care tests (POCTs) offer a new paradigm for the management of patients with influenza?


Elizabeth M Dickson[SUP] 1 2 [/SUP], Maria Zambon[SUP] 3 [/SUP], Richard Pebody[SUP] 4 [/SUP], Simon de Lusignan[SUP] 5 [/SUP], Alex J Elliot[SUP] 6 [/SUP], Joanna Ellis[SUP] 3 [/SUP], Angie Lackenby[SUP] 3 [/SUP], Gillian Smith[SUP] 6 [/SUP], Jim McMenamin[SUP] 1 [/SUP]



Affiliations

Abstract

The introduction of point-of-care tests (POCTs) has presented new opportunities for the management of patients presenting to healthcare providers with acute respiratory symptoms. This Perspective article is based on the experiences of national infection teams/those managing acute respiratory infections across the United Kingdom in terms of the challenges and opportunities that this may present for public health. This Perspective article was conceived and written pre-coronavirus disease (COVID-19), however the principles we outline here for influenza can also be translated to COVID-19 and some key points are made throughout the article. The greatest challenge for intergrating POCTs into non-traditional environments is the capture of data and samples for surveillance purposes which provides information for public health action. However, POCTs together with measures outlined in this article, offer a new paradigm for the management and public health surveillance of patients with influenza.

Keywords: Influenza; challenges; opportunities; patient management; point of care testing.
 
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