Friday, September 29, 2023

Point Of Care Flu Testing

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Specimen Collection And Shipping To Ma Sphl

Point-of-Care Testing with BD Veritor

Flu specimens should be collected as soon as possible after onset of illness, preferably within three days . Specimens collected after 72 hours are usually unsuitable for testing. Specimens should be submitted immediately after collection to MA SPHL, in order to be tested within three days of collection. If samples will be shipped to MA SPHL > 3 days from collection or on a Friday, but are collected within 72 hours, they should be frozen at < -20ºC and shipped with ice packs on Monday. This variation must be noted on the specimen submission form to avoid an unsatisfactory for testing designation.

Find State Public Health Laboratory specimen submission forms in the downloads section of the Influenza information for healthcare and public health professionals handbook.

Types Of Influenza Tests

The first step in diagnosing influenza is almost always a physical examination that includes a review of any active flu-like symptoms. During seasonal flu epidemics, additional testing beyond a physical exam may not be needed to diagnose influenza.

When other tests are needed, they focus on identifying signs of an influenza infection. There are several different tests that can check for the presence of an influenza virus. The choice of which test to prescribe depends on the purpose of testing, how quickly results are needed, test availability, and laboratory capabilities.

One important way that influenza tests can be categorized is based on where the analysis is conducted:

  • Rapid, point-of-care tests, sometimes called rapid influenza diagnostic tests , are able to determine whether the test is positive or negative without sending the sample to a lab. These tests usually provide results within 10 to 30 minutes. The design of these tests allows them to be used in many settings including doctors offices, health clinics, and pharmacies.
  • Laboratory tests require that the sample be analyzed using equipment or methods that require the use of a medical lab. These tests often take several hours to complete and are not as widely available as rapid tests.

Another important way of categorizing tests is based on how they detect signs of an infection:

Antigen testing can also be done in a laboratory. Laboratory-based antigen testing can take longer but may provide more accurate results.

More Than Ever Diagnostics Are Needed To Appropriately Identify Treat And Control Spread

Early research shows that co-infection between COVID-19 and influenza is possible, and may lead to worse patient outcomes, which means that monitoring for both illnesses is especially important in the upcoming flu season.

  • Experimental co-infection found that influenza A virus pre-infection significantly promoted the infectivity of SARS-CoV-2. 4
  • A review of literature concluded that coinfection occurs, the pathophysiology is complex, and that coinfection leads to greater pulmonary damage. 5
  • A single-center study found patients coinfected with SARSCoV2 and influenza B virus have a higher risk of developing poor outcomes 6
White Paper: SARS-CoV-2 Coinfection – Influenza and Other Pathogens

WHO guidelines support testing for both influenza and SARS-COV-27

The World Health Organization urges countries to remain vigilant in testing practices for influenza during COVID-19.

Adequate testing to ensure effective detection and surveillance of influenza and SARS-CoV-2 is critical for appropriate action.– WHO on virus differentiation

The two infections often have similar clinical presentation . It is thus necessary to distinguish between the two viruses and associated diseases.– WHO on testing high risk patients

Patients with severe or complicated disease or those with risk factors should be tested using a rapid molecular assay when results can be made available within 24 hours

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Pharmacists Treating Minor Conditions

Journal of the American Pharmacists Association

State Minor conditions treatable by pharmacists
Skin conditions
Uncomplicated infections
Minor conditions included in the Clinical Community Pharmacist Training provided by Washington State Pharmacy Association. Allergic rhinitis
Human, canine, and feline bite prophylaxis
Insect stings
Vaginal yeast infections

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The American Hospital Association has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

Rates Of Healthcare Associated Influenza Virus

In period 1 25 of the 51 cases were identified after 72h of admission. Fewer healthcare associated influenza virus were identified in period 2 with 64 of the 666 cases identified after 72h of admission. A chi squared test was used to check for equality of proportions between period 1 and 2. A p< 0.001 provided very strong evidence that the proportions differ. The 95% confidence interval for the difference in the two proportions was .

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Description Of Guideline Consistent Or Inconsistent Care

Overall, 193 of the 1,035 patients in both groups received guideline inconsistent care . Of 312 patients given oseltamivir, 10 did not have a PCR-positive test or a clinical diagnosis of influenza. Of 191 patients given an antibiotic, only 24 were at high risk of pneumonia or were given a diagnosis consistent with bacterial infection. Of all patients who received oseltamivir, 27.5% had a duration of symptoms greater than 48 hours. In the PCR guided care group, 27 of 122 patients with a negative PCR test were still given a final clinical diagnosis of influenza, and 5 of those 27 patients received oseltamivir. In the usual care group, 537 of 772 patients did not receive a rapid influenza test, of whom 66 received an oseltamivir prescription based on clinical diagnosis. Finally, the PCR guided care group had no significant difference in the odds of receiving guideline consistent care compared to the usual care group in univariate logistic regression analysis .

Appropriate Use Of Antimicrobials

Dr. Hahn introduces the point-of-care coronavirus testing machine

Using rapid and point-of-care influenza tests may help clinicians more appropriately prescribe antibiotics and antiviral medications.58,59,65,66

Two small 2014 studies examined the effect of positive point-of-care test results on physician-prescribing of antibiotics.65,66 Both concluded that point-of-care tests may help reduce the use of antibiotics. Similarly, the retrospective analysis of 4.9 million US emergency department visits found patients received fewer antibiotics if they tested positive for influenza by rapid antigen testing.59 However, in its 2014 systematic review of rapid viral testing of children presenting to the emergency department with acute respiratory infection, the Cochrane Collaboration found no evidence to support the use of routine rapid testing to reduce antibiotic use in children.58

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Intervention And Outcome Variable Definitions

Our intervention was the type of care a patient received , and our outcome was guideline consistent care . A patient was considered influenza positive if they had a positive rapid point of care PCR test or a final clinical diagnosis of influenza. The definition of influenza positive included both the PCR-based and final clinician diagnosis because not all patients in the usual care group received a point of care test. A patient was considered influenza negative if they had a negative rapid point of care PCR test and no final clinical diagnosis of influenza.

defines guideline consistent and guideline inconsistent treatment depending on the diagnosis. Oseltamivir is only guideline consistent when administered within 48 hours of symptom onset in patients with influenza confirmed by PCR or clinician diagnosis per the Food and Drug Administration. Antibiotics are guideline consistent in patients with a high risk of pneumonia or a final clinical diagnosis of a bacterial infection. Patients with a final diagnosis of acute otitis media or acute bacterial rhinosinusitis were excluded because antibiotic prescriptions are recommended for selected patients based on US treatment guidelines., Patients who are diagnosed with influenza more than 48 hours after symptom onset, that do not have influenza, are at low risk for pneumonia, and do not have a bacterial infection as a clinical diagnosis should not receive oseltamivir or antibiotics.

The Severity Of The Upcoming Covid

As social distancing measures decrease, influenza transmission may increase.1 At the same time, experts believe that COVID-19 will continue to circulate endemically. As a result, both COVID-19 and flu are likely to co-circulate. Rapid testing remains an important to manage respiratory illness unpredictability.2

Register for Abbott’s webinar series “The evolving role of rapid testing for COVID-19 and beyond

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Characteristics Of Included Studies

There were 7 randomized trials , including 1 quasi-randomized and 1 cluster randomized trial . Usual care varied. Four trials used no test , 2 used laboratory-based influenza tests , and 1 used the POCT in the comparator group but concealed the result . The remaining 6 studies were not randomized studies . Two compared records before and after the introduction of POCTs to Korean emergency departments , and 1 compared tested and untested patients in Greek primary care home visit records . Three nonrandomized studies were more experimental, 1 compared what clinicians said their clinical decisions would be before and after revealing the test results , 1 was a single-blinded trial in which allocation was not clearly randomized , and 1 was a prospective open cohort .

Six randomized trials were conducted in emergency departments, and 1 cluster RCT was performed in a primary care setting . Four nonrandomized studies were in emergency departments , and 2 were in primary care settings . The age of participants varied, but pediatric populations were dominant, and most evidence comes from children aged < 5 years. All randomized trials and 3 nonrandomized studies were in children. Three nonrandomized studies included adults and children , 2 included children aged < 5 years , and 1 included children aged 3 to 14 years .

Cost Evaluation Of Point

Global Point

Rapid point of care influenza tests are sensitive and specific.

Real-world patient level costing data is used to evaluate a rapid influenza test.

Patients who had a rapid influenza test cost 67 % less than those who did not.

Rapid influenza testing in emergency departments produces significant cost savings.

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Effect Of Pcr Guided Care On Guideline Consistent Care

The final adjusted logistic regression model is shown in . The association between use of the PCR test and a greater likelihood of guideline consistent care was not statistically significant , with a trend favoring guideline consistent care in the PCR guided care group. The Hosmer-Lemeshow Ï2 statistic was 10.9 with a P value of 0.21, indicating a good fit, and the area under the receiver operating characteristic curve was 0.77.

Final Adjusted Model*â for the Likelihood of Guideline Consistent Antiviral Prescription

Cms National Coverage Policy

  • Available at the point of care
  • Yields a Flu A and Flu B result in < 30 minutes
  • Less sensitive and specific compared to other methods and may require confirmation with another method
  • CDC recommendation:
    • During early winter months, providers should confirm negative rapid flu test results with a more sensitive method, such as viral culture or a nucleic acid amplification test .
    • Outside of flu season, providers should consider confirming positive rapid flu test results.

Targeted Molecular Methods:

  • Uses transcriptase-polymerase chain reaction or isothermal amplification methods to detect viral nucleic acids
  • Results available in < 24 hours
  • Detects from 1-2 to up to 20 respiratory pathogens from one specimen

Viral Culture:

  • Results available in 3-10 days
  • Misses opportunity for Tamiflu treatment for positive patients

CPT® Coding Guidance for Diagnostic Tests:


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Influenza Diagnosis And Point

Search Strategy: Recognizing Influenza diagnosis is an annual issue, you turn to PUBMED Clinical Queries searching Influenza under the diagnosis tab requesting initially a narrow/specific search yielding 5695 hits. You conduct a second search of JAMA and then combine the two search results to yield 30 citations, the second of which is a systematic review of influenzas clinical diagnosis. Similarly, searching Emergency Medicine combined with the clinical query search of Influenza yields four citations including a recent Annals of Emergency Medicine review of unaided clinical diagnosis, clinical decision rule guided diagnosis, and rapid Influenza testing. Finally, a general PUBMED search of Influenza Point of Care Test yields 23 references, two of which concern use of these bedside tests in ED children.

A 39-year old lawyer presents to your ED in mid-December with one-day history of fever, sore throat, and myalgias. He denies any prior medical history. Review of your hospital records reveals no prior ED evaluations or hospital admissions. His physical exam is unremarkable except for a temperature of 38.6C and rhinnorhea. Youve not seen or heard of a confirmed case of Influenza in your community yet, but you contemplate whether todays case might be your first taste of an impending long winter.

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Understanding Point-of-Care Testing

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New Molecular Technology Raises The Bar For Point

Today, a new generation of rapid, easy-to-use flu tests offer unprecedented speed and exceptional clinical performance. Called ID NOW, the new molecular platform no longer forces physicians and healthcare administrators to make tradeoffs during flu season, improving both patient experience and clinical efficacy.

When healthcare providers select an influenza diagnostic platform for their practice or hospital system, they consider a wide range of factors. These include the anticipated severity of the upcoming flu season, patient volume and the availability of clinicians trained to administer different types of tests.

Historically, the two attributes of influenza diagnostics most often considered have been speed, traditionally provided by rapid antigen tests, and accuracy, traditionally the exclusive domain of lab-based molecular culture platforms.

This new era of diagnosis began in 2014 with the launch of Abbotts Influenza A & B assay on the ID NOW platform, the first-ever molecular flu test designed for use at the point of care . Today, ID NOW and other POC molecular platforms allow clinicians to make more informed diagnoses and treatment decisions during a patient visit. With molecular testing transitioning from the lab to the point of care, accurate diagnosis can be seamlessly integrated into clinical practice.

Todays latest-generation POC molecular testing platforms offer important benefits for both patients and providers:

Diagnosing The Flu On The Fly: Point

Most of us take measures during flu season to avoid catching the influenza virus , such as getting the flu shot and using proper handwashing, sneeze, and cough etiquette. But each year, an estimated 10 to 20 per cent of Canadians become infected with influenza. Most will get better by staying at home to rest. But, for others, influenza can be much more serious even deadly.

In Canada, about 12,000 people are hospitalized and 3,500 die as a result of serious complications from the influenza virus every year. Those at a higher risk of developing complications include very young children, people over 65 years of age, pregnant women, and people with chronic illnesses or weakened immune systems. When these people get the flu, they sometimes need antiviral medications to recover.

For patients at high risk of flu complications who are experiencing flu symptoms, a lab test is sometimes used to confirm the diagnosis before antivirals are prescribed. Flu symptoms can be similar to those caused by a bacterial infection. Although lab tests are very reliable, they can take several hours to several days for results. Because of this delay, clinicians often send patients home on antibiotics, just in case the test comes back negative. However, antibiotics are not effective at treating the flu virus, and overuse of antibiotics can lead to antibiotic resistance.

Barbara Greenwood Dufour is a Knowledge Mobilization Officer at CADTH.

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Quick Answers For Clinicians

In most healthy individuals, the flu is self-limited and uncomplicated. In high-risk individuals , the flu can result in serious complications, including hospitalization and increased mortality risk. The Infectious Diseases Society of America and the CDC recommend testing if the results will influence management decisions, such as whether to initiate antiviral therapy. If influenza has been documented in the area, testing is not necessary for otherwise healthy outpatients with signs and symptoms consistent with influenza. See the Indications for Testing section for specific testing recommendations.

Laboratory testing is the only way to distinguish between SARS-CoV-2 and the flu. Importantly, laboratory testing is also the only way to determine cases of viral coinfection. Infection with one respiratory virus does not exclude the possibility of infection with another because patients may be infected with more than one virus at the same time. When SARS-CoV-2, influenza, and respiratory syncytial virus are cocirculating , the National Institute of Health recommends cotesting to determine proper medical management.

Ideally, influenza testing should occur as soon as possible after illness onset, using respiratory specimens collected within 4 days of symptom onset.

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