About: Routine molecular point-of-care testing for respiratory viruses in adults presenting to hospital with acute respiratory illness (ResPOC): a pragmatic, open-label, randomised controlled trial

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About: Routine molecular point-of-care testing for respiratory viruses in adults presenting to hospital with acute respiratory illness (ResPOC): a pragmatic, open-label, randomised controlled trial Goto Sponge NotDistinct Permalink

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type	Academic Article research paper schema:ScholarlyArticle
isDefinedBy	Covid-on-the-Web dataset
has title	Routine molecular point-of-care testing for respiratory viruses in adults presenting to hospital with acute respiratory illness (ResPOC): a pragmatic, open-label, randomised controlled trial
Creator	Aitken, Sandra Armstrong, Lawrence Ewings, Sean Houghton, Rebecca Nyimbili, Esther Lillie, Patrick Brendish, Nathan Clark, Tristan Malachira, Ahalya
Source	Elsevier; Medline; PMC
abstract	Summary Background Respiratory virus infection is a common cause of hospitalisation in adults. Rapid point-of-care testing (POCT) for respiratory viruses might improve clinical care by reducing unnecessary antibiotic use, shortening length of hospital stay, improving influenza detection and treatment, and rationalising isolation facility use; however, insufficient evidence exists to support its use over standard clinical care. We aimed to assess the effect of routine POCT on a broad range of clinical outcomes including antibiotic use. Methods In this pragmatic, parallel-group, open-label, randomised controlled trial, we enrolled adults (aged ≥18 years) within 24 h of presenting to the emergency department or acute medical unit of a large UK hospital with acute respiratory illness or fever higher than 37·5°C (≤7 days duration), or both, over two winter seasons. Patients were randomly assigned (1:1), via an internet-based allocation sequence with random permuted blocks, to have a molecular POC test for respiratory viruses or routine clinical care. The primary outcome was the proportion of patients who received antibiotics while hospitalised (up to 30 days). Secondary outcomes included duration of antibiotics, proportion of patients receiving single doses or brief courses of antibiotics, length of stay, antiviral use, isolation facility use, and safety. Analysis was by modified intention to treat, excluding patients who declined intervention or were withdrawn for protocol violations. This study is registered with ISRCTN, number 90211642, and has been completed. Findings Between Jan 15, 2015, and April 30, 2015, and between Oct 1, 2015, and April 30, 2016, we enrolled 720 patients (362 assigned to POCT and 358 to routine care). Six patients withdrew or had protocol violations. 301 (84%) of 360 patients in the POCT group received antibiotics compared with 294 (83%) of 354 controls (difference 0·6%, 95% CI −4·9 to 6·0; p=0·84). Mean duration of antibiotics did not differ between groups (7·2 days [SD 5·1] in the POCT group vs 7·7 days [4·9] in the control group; difference −0·4, 95% CI −1·2 to 0·4; p=0·32). 50 (17%) of 301 patients treated with antibiotics in the POCT group received single doses or brief courses of antibiotics (<48 h) compared with 26 (9%) of 294 patients in the control group (difference 7·8%, 95% CI 2·5 to 13·1; p=0·0047; number needed to test=13). Mean length of stay was shorter in the POCT group (5·7 days [SD 6·3]) than in the control group (6·8 days [7·7]; difference −1·1, 95% CI −2·2 to −0·3; p=0·0443). Appropriate antiviral treatment of influenza-positive patients was more common in the POCT group (52 [91%] of 57 patients) than in the control group (24 [65%] of 37 patients; difference 26·4%, 95% CI 9·6 to 43·2; p=0·0026; number needed to test=4). We found no differences in adverse outcomes between the groups (77 [21%] of 360 patients in the POCT group vs 88 [25%] of 354 patients in the control group; −3·5%, −9·7 to 2·7; p=0·29). Interpretation Routine use of molecular POCT for respiratory viruses did not reduce the proportion of patients treated with antibiotics. However, the primary outcome measure failed to capture differences in antibiotic use because many patients were started on antibiotics before the results of POCT could be made available. Although POCT was not associated with a reduction in the duration of antibiotics overall, more patients in the POCT group received single doses or brief courses of antibiotics than did patients in the control group. POCT was also associated with a reduced length of stay and improved influenza detection and antiviral use, and appeared to be safe. Funding University of Southampton.
has issue date	2017-05-31(xsd:dateTime)
bibo:doi	10.1016/s2213-2600(17)30120-0
bibo:pmid	28392237
has license	els-covid
sha1sum (hex)	9c3e0cd578707c9e43576904116e9a4b5b3178fd
schema:url	https://doi.org/10.1016/s2213-2600%2817%2930120-0
resource representing a document's title	Routine molecular point-of-care testing for respiratory viruses in adults presenting to hospital with acute respiratory illness (ResPOC): a pragmatic, open-label, randomised controlled trial
has PubMed Central identifier	PMC7164815
has PubMed identifier	28392237
schema:publication	The Lancet Respiratory Medicine
resource representing a document's body	covid:9c3e0cd578707c9e43576904116e9a4b5b3178fd#body_text
is schema:about of	named entity 'infection' named entity 'acute' named entity 'point-of-care testing' named entity 'respiratory illness' covid:arg/9c3e0cd578707c9e43576904116e9a4b5b3178fd named entity 'point-of-care testing' named entity 'assess' named entity 'viruses' named entity 'virus infection' named entity 'length of hospital stay' named entity 'influenza' named entity 'antibiotic' named entity 'respiratory illness' named entity 'Rapid' named entity 'POCT' named entity 'viral testing' named entity 'lower respiratory tract infection' named entity 'POCT' named entity 'antibiotics' named entity 'POCT' named entity 'antiviral' named entity 'pneumonia' named entity 'adjusted odds ratio' named entity 'isolation facility' named entity 'Neuraminidase inhibitor' named entity 'point-of-care testing' named entity 'control group' named entity '95% CI' named entity 'respiratory syncytial virus' named entity 'respiratory illness' named entity 'influenza' named entity 'antibiotic' named entity 'viruses' named entity 'POCT' named entity 'influenza' named entity 'POCT' named entity 'POCT' named entity 'diagnostic accuracy' named entity 'POCT' named entity 'respiratory illness' named entity 'control group' named entity 'randomised controlled trial' named entity 'palliative' named entity 'control group' named entity 'neuraminidase' named entity 'COPD' named entity 'molecular testing' named entity 'respiratory illness' named entity 'randomised controlled trials' named entity 'ClinicalTrials.gov' named entity 'influenza' named entity 'antibiotics' named entity 'control group' named entity 'PCOT' named entity 'respiratory illness' named entity 'viruses' named entity 'intravenous antibiotics' named entity 'molecular testing' named entity 'antibiotics' named entity 'antibiotic' named entity 'NHS' named entity 'antibiotic' named entity 'control group' named entity 'influenza' named entity 'POCT' named entity 'influenza' named entity 'control group' named entity 'control group' named entity 'viruses' named entity 'POCT' named entity 'antiviral' named entity 'human health' named entity 'antibiotics'

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