Myrte van der Kraan1, Elke L Hobbelink2, Jayant Kalpoe3, Sjoerd M Euser3, Dominic Snijders4, Dennis Souverein5. 1. Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, The Netherlands. Electronic address: myrtevdkraan@gmail.com. 2. Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, The Netherlands. 3. Department of Epidemiology and Infection Prevention, Regional Public Health Laboratory Kennemerland, Haarlem, The Netherlands. 4. Department of Pulmonary Medicine, Spaarne Gasthuis, Haarlem, The Netherlands. 5. Department of Epidemiology and Infection Prevention, Regional Public Health Laboratory Kennemerland, Haarlem, The Netherlands.. Electronic address: d.souverein@streeklabhaarlem.nl.
Abstract
INTRODUCTION: Influenza poses a heavy burden on emergency departments (ED) and hospital wards. Fast and reliable bedside tests are invaluable in obtaining indications for (cohort) droplet isolation precautions and improving patient flow. We performed a cost-benefit analysis comparing influenza point-of-care testing (POCT) to laboratory-based multiplex ligation-dependent probe amplification. METHODS: Data of 275 ED presentations between January-April 2019 were analyzed. Patients received both POCT and MLPA to calculate POCT sensitivity and specificity. Costs were calculated for both a POCT and MLPA scenario, including costs for testing, admission, droplet isolation precautions and cleaning. RESULTS: In our study population, 34 patients (12%) were identified with influenza A. No cases of influenza B were identified. Mean age of the influenza positive patients was 75(18) years and 56% were male. The most common symptoms upon presentation were cough, malaise and fever, with 74%, 56% and 50%, respectively. Compared to MLPA, POCT yielded a sensitivity of 94%, a specificity of 98% and a negative predictive value of 99% for influenza A. Using POCT yielded a cost reduction of €93,26 per patient. CONCLUSIONS: Influenza POCT is an accurate and cost-beneficial method to differentiate between admission with or without droplet isolation precautions. It can be useful in clinical decision making and reducing pressure on ED and hospital beds in an influenza peak season, by enabling fast patient flow and cohort isolation.
INTRODUCTION: Influenza poses a heavy burden on emergency departments (ED) and hospital wards. Fast and reliable bedside tests are invaluable in obtaining indications for (cohort) droplet isolation precautions and improving patient flow. We performed a cost-benefit analysis comparing influenza point-of-care testing (POCT) to laboratory-based multiplex ligation-dependent probe amplification. METHODS: Data of 275 ED presentations between January-April 2019 were analyzed. Patients received both POCT and MLPA to calculate POCT sensitivity and specificity. Costs were calculated for both a POCT and MLPA scenario, including costs for testing, admission, droplet isolation precautions and cleaning. RESULTS: In our study population, 34 patients (12%) were identified with influenza A. No cases of influenza B were identified. Mean age of the influenza positive patients was 75(18) years and 56% were male. The most common symptoms upon presentation were cough, malaise and fever, with 74%, 56% and 50%, respectively. Compared to MLPA, POCT yielded a sensitivity of 94%, a specificity of 98% and a negative predictive value of 99% for influenza A. Using POCT yielded a cost reduction of €93,26 per patient. CONCLUSIONS: Influenza POCT is an accurate and cost-beneficial method to differentiate between admission with or without droplet isolation precautions. It can be useful in clinical decision making and reducing pressure on ED and hospital beds in an influenza peak season, by enabling fast patient flow and cohort isolation.
Authors: Josef Stolberg-Stolberg; Elena Jacob; Joachim Kuehn; Marc Hennies; Wali Hafezi; Moritz Freistuehler; Jeanette Koeppe; Alex W Friedrich; J Christoph Katthagen; Michael J Raschke Journal: Eur J Trauma Emerg Surg Date: 2022-09-06 Impact factor: 2.374