PM3049: Practice Patterns and Perceptions of Influenza Diagnostic Testing Amongst Pediatric Urgent Care Providers

Background: Influenza is a common acute respiratory infection that causes significant morbidity and mortality worldwide. Rapid diagnosis and treatment with Oseltamivir can reduce complications and duration of illness. The Infectious Disease Society of America recommends treatment for patients < 2 years of age or those with comorbidities that place them at risk for complications. Providers can empirically treat with oseltamivir based on clinical assessment, without delaying care due to pending lab results. However, treatment exposes the patient to adverse effects, including vomiting, neuropsychiatric illness as well as high cost ($65-154, $20-45 with good rx coupon). Providers may prefer to prescribe oseltamivir only when there is high certainty in the diagnosis. Therefore, the high specificity >99% and positive predictive value of rapid influenza diagnostic testing (RIDT), rapid turn-around time, and low cost makes RIDT a useful tool in diagnosing influenza and influencing a provider’s decision to prescribe Oseltamivir in the urgent care setting.

Methods: A quantitative study using a web-based survey was distributed to all members of the Society of Pediatric Urgent Care of which includes physicians, physician assistants, and nurse practitioners practicing primarily in acute or urgent care settings. Respondents rated their confidence in diagnosing influenza, likelihood of RIDT use, and likelihood of antiviral prescribing using a 5-point Likert scale.

Results: Sixty-one of the 305 (20%) recipients completed our survey. Forty-two percent (95% CI 29.5-54.5%) of respondents report higher confidence in their diagnosis of influenza with the aid of a positive RIDT, especially among those who practice in urban communities and urgent care centers within a hospital or emergency department. Providers also report higher likelihood of utilizing RIDT for patients < 2 years of age, and with symptoms < 48 hours. In those >2 years of age without co-morbidities, the frequency of prescribing antiviral treatment for influenza was not significantly influenced by RIDT results.

Conclusion: Most pediatric urgent care providers reported higher confidence in their diagnosis of influenza with RIDT to confirm their clinical suspicions. They report higher likelihood of using this lab test for patients < 2 years, especially if symptomatic for < 48 hours as these patients would experience the most benefit from treatment. This may reflect an intent to screen for patients who would benefit from treatment, or support a decision to avoid exposing a patient without influenza to side effects. Our study shows that RIDT continues to play a decisive role among pediatric acute care providers to diagnose and treat influenza among patients < 2 years of age and those with < 48 hours of illness. Fewer providers utilize RIDT or base antiviral treatment decisions on the test result in patients older than 2 years with >48 hours of symptoms.