A Randomized, Controlled Trial of the Impact of Early and Rapid Diagnosis of Viral Infections in Children Brought to an Emergency Department with Febrile Respiratory Tract Illnesses

Objectives Acute respiratory tract infections represent a significant burden on pediatric emergency departments (ED) and families. We hypothesized that early and rapid diagnosis of a viral infection alleviates the need for ancillary testing and antibiotic treatment. Study design We conducted a randomized, controlled trial of children 3 to 36 months of age with febrile acute respiratory tract infections at a pediatric ED. Two hundred four subjects were randomly assigned to receive rapid respiratory viral testing on admission or a routine E D admission protocol. Outcome measures were: mean length of visits. rate of ancillary tests, and antibiotic prescription in the ED. A follow-up call was made to all study subjects to inquire about further healthcare visits, ancillary testing. and antibiotic prescription after ED discharge. Results We did not find a statistically significant difference in ED length of visits, rate of ancillary testing, or antibiotic prescription rate in tire ED between the study groups. There was, however, a significant reduction in antibiotic prescription after ED discharge (in tire group who had rapid viral testing RR = 0.36, 95% CI = 0.1.4, 0.95). Conclusions Rapid multi-viral testing in the ED did not significantly affect ED patient treatment but may reduce antibiotic prescription in the community after discharge front the ED, suggesting a novel strategy to alter community physician antibiotic prescription patterns. (J Pediatr 2009,154:9.1-5)