Original Investigation
Less Is More
March 4, 2024
Clinical Outcomes of Rapid Respiratory Virus Testing in Emergency Departments: A Systematic Review and Meta-Analysis
Tilmann Schober, Kimberly Wong, Gaëlle DeLisle, et al
JAMA Intern Med. 2024;184(5):528-536. doi:10.1001/jamainternmed.2024.0037
Question Is rapid testing for respiratory viruses associated with patient treatment in the emergency department (ED)?
Findings In this systematic review and meta-analysis of 11 randomized clinical trials, rapid viral testing was not associated with reduced antibiotic use, ED length of stay, and the rate of ED return visits or of hospitalization. However, rapid viral testing was associated with moderately increased influenza antiviral use (absolute risk difference 1%) and decreased use of chest radiography and blood tests (absolute risk difference, 3%-4% each).
Meaning The results of this meta-analysis suggest that the benefits of ED rapid viral testing are limited for the general population.
Abstract
Importance Rapid tests for respiratory viruses, including multiplex panels, are increasingly available in emergency departments (EDs). Their association with patient outcomes remains unclear.
Objective To determine if ED rapid respiratory virus testing in patients with suspected acute respiratory infection (ARI) was associated with decreased antibiotic use, ancillary tests, ED length of stay, and ED return visits and hospitalization and increased influenza antiviral treatment.
Data Sources Ovid MEDLINE, Embase (Ovid), Scopus, and Web of Science from 1985 to November 14, 2022.
Study Selection Randomized clinical trials of patients of any age with ARI in an ED. The primary intervention was rapid viral testing.
Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines were followed. Two independent reviewers (T.S. and K.W.) extracted data and assessed risk of bias using the Cochrane Risk of Bias, version 2.0. Estimates were pooled using random-effects models. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations framework.
Main Outcomes and Measures Antibiotic use and secondary outcomes were pooled separately as risk ratios (RRs) and risk difference estimates with 95% CIs.
Results Of 7157 studies identified, 11 (0.2%; n = 6068 patients) were included in pooled analyses. Routine rapid viral testing was not associated with antibiotic use (RR, 0.99; 95% CI, 0.93-1.05; high certainty) but was associated with higher use of influenza antivirals (RR, 1.33; 95% CI, 1.02-1.75; moderate certainty) and lower use of chest radiography (RR, 0.88; 95% CI, 0.79-0.98; moderate certainty) and blood tests (RR, 0.81; 95% CI, 0.69-0.97; moderate certainty). There was no association with urine testing (RR, 0.95; 95% CI, 0.77-1.17; low certainty), ED length of stay (0 hours; 95% CI, −0.17 to 0.16; moderate certainty), return visits (RR, 0.93; 95%, CI 0.79-1.08; moderate certainty) or hospitalization (RR, 1.01; 95% CI, 0.95-1.08; high certainty). Adults represented 963 participants (16%). There was no association of viral testing with antibiotic use in any prespecified subgroup by age, test method, publication date, number of viral targets, risk of bias, or industry funding.
Conclusions and Relevance The results of this systematic review and meta-analysis suggest that there are limited benefits of routine viral testing in EDs for patients with ARI. Further studies in adults, especially those with high-risk conditions, are warranted.
