Point-of-care testing for influenza in a university emergency department
(ED): A prospective study
Background: Seasonal influenza is a burden for emergency departments.
The aim of this study was to investigate whether point-of-care (POC) PCR
testing can be used to reduce staff sick days and improve diagnostic and
therapeutic procedures. Methods: Using a cross-over design, the cobas®
Liat® Influenza A/B POC PCR test (Liat) was compared to standard
clinical practice during the 2019/2020 influenza season. All adult
patients (aged ≥18 years) with fever (≥38°C) and respiratory symptoms
were included. Primary endpoints were prevalence of influenza infections
in the ED and staff sick days. Secondary endpoints were frequency of
antiviral and antibacterial therapy, time between admission and test
result or treatment initiation, patient disposition, ED length of stay
(LOS) and for in-patients mortality and LOS. Nurses were interviewed
about handling and integration of POC testing. The occurrence of
SARS-CoV-2 infections coincided with the second half of the study.
Results: A total of 828 patients were enrolled in the study. All 375
patients of the intervention group were tested with Liat, 103 of them
(27.6%) tested positive. During the intervention period staff sick days
were reduced by 34.4% (p=0.023). Significantly more patients in the
intervention group received antiviral therapy with
neuraminidase-inhibitors (7.2% vs. 3.8%, p=0.028) and tested patients
received antibiotics more frequently (40.0% vs. 31.6%, p=0.033).
Patients with POC test were transferred to external hospitals
significantly more often (5.6% vs. 1.3%, p=0.01). Conclusion: We
conclude that POC testing for influenza is useful in the ED, especially
if it is heavily frequented by patients with respiratory symptoms.