684 - The impact of rapid molecular respiratory testing on provider and parental decision making for children with respiratory illness evaluated in an ED setting

Background: Rapid respiratory testing (RRT) can decrease ancillary testing, length of stay and antibiotic use for hospitalized children. Less is known regarding the impact of RRT in the emergency department (ED). 
Our objectives were to determine if RRT impacts ED provider clinical decision making, family acceptance, and subsequent healthcare visitation for children with influenza-like illness (ILI).

Methods: Randomized controlled trial of children 1 month-18 years of age presenting to a tertiary care pediatric ED with ILI. All children received a nasopharyngeal swab and RRT and were randomized to the intervention group (RRT result given to clinicians/families) or control group (results not available unless obtained clinically). Outcomes included provider decision-making (anti-infective prescribing, ED diagnostic testing, disposition), family acceptance of RRT (willingness to undergo future testing) and repeat healthcare visits (clinic or ED). Providers in the intervention group were surveyed after RRT results were available, and families in both arms were contacted 1 and 10 days later.

Results: There were 920 ED visits from 908 enrolled children; 629 (68%) families from both arms and 443 (96%) providers from the intervention arm completed surveys.  Most providers (33%) were ED trained and < 5 years post-training (37%). Clinical decisions were changed in 17% of visits based on RRT results, most commonly by ED trained physicians, advanced practice providers, and those < 5 years post-training (Table). The most common decision changes were antiviral use and avoidance of diagnostic tests (Figure). Families were more willing to undergo future RRT if they were in the intervention group, or if RRT results were available in 20 minutes. In the control arm, 22 families (7%) stated they would not have sought additional medical visits if RRT results were available. In the intervention group, 20 families (6.7%) reported that the RRT influenced how their child received care, and 14 families (17%) sought additional care due to RRT results.Figure. Provider Clinical Decision Making Based on Results of Rapid Respiratory Testing, n = 443
Characteristics of providers and patients by provider decision type


Conclusion: RRT impacts clinical decision making for 1 in 5 ED visits, specifically antiviral prescribing and reduced diagnostic testing. Most families were in favor of RRT, which impacts additional health care visits after the ED encounter.