Effect of Rapid Diagnosis of Influenza Virus Type A on the Emergency Department Management of Febrile Infants and Toddlers

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Abstract
Background Evidence shows that the rapid detection of influenza using an enzyme-linked immunosorbent assay decreases antibiotic use in the treatment of pediatric patients. To our knowledge, the effect on other diagnostic testing in an emergency department (ED) has not been examined. Objective To determine the effect of rapid diagnosis of influenza virus type A on the clinical management of febrile infants and toddlers in a pediatric ED at an urban children's hospital. Materials and Methods A retrospective review of ED records from an electronic database was performed. All children 2 to 24 months of age, with a temperature higher than 39°C who had a positive influenza virus type A test result using an enzyme-linked immunosorbent assay from November 1, 1998, through April 30, 2000 (n = 72), were included in this study. Two groups were compared—those who had positive test results reported before discharge from the ED (early diagnosis) and those who had positive test results after discharge (late diagnosis). Results Forty-seven patients (65%) were in the early diagnosis group and 25 (35%) in the late diagnosis group. The groups were similar for age, temperature, and triage category. Fewer patients in the early diagnosis group received ceftriaxone sodium compared with those in the late diagnosis group (2% vs 24%,P= .006); there were fewer urinalyses (2% vs 24%,P= .006) and complete blood cell counts performed (17% vs 44%,P= .02). Conclusions Rapid confirmation of influenza virus type A infection seems to decrease ancillary tests and antibiotic use in febrile infants and toddlers in the ED. A prospective study with a larger group is needed to confirm these findings.