Point-of-care Testing of Respiratory Pathogens at Pediatric Emergency Room (Hevi-RCT)

Impact of Multiplex Respiratory Pathogen Testing on Antimicrobial Consumption and Hospital Admissions at Pediatric Emergency Room: A Randomized Controlled Trial

The main objective of the trial is to evaluate the effect of point-of-care testing of respiratory pathogens at a pediatric emergency room on the antibiotic consumption and hospital admissions in acutely ill children.

The study is a randomized controlled trial including children 0 up to 17 years of age with fever or acute respiratory infection at a pediatric emergency department in university hospital. In total 1668 subjects will be randomly allocated to undergo point-of-care multiplex respiratory pathogen testing with results ready within approximately one hour or to a control group with testing according to clinical judgement and results ready within next office day. Subjects will be randomized on admission and unequal allocation ratio of 2:1 (1112 subjects to intervention and 556 subjects to control arm) will be used. Data on rate of hospitalization, antibiotic prescriptions, ancillary testing and length of visit will be collected using medical record system.

Anti-bacterial agents, Emergency room, Respiratory pathogen, Point-of-care testing, Patient admission, Pediatrics, Pediatric emergency medicine, Cost-benefit analysis, Antimicrobial stewardship

Point-of-care testing of respiratory pathogens on admission. The subjects will receive the point-of-care testing of respiratory pathogens at pediatric emergency room. The results are ready within 1 one hour.

Diagnostic tests for respiratory pathogens will be obtained according to clinical judgement and tested on microbiological laboratory. The results are ready on the next office day.

Pediatric acute care nurses will obtain respiratory samples for testing from all patients with fever or any respiratory symptom.

Proportion of children with hospital readmission or emergency room revisit within 7 days after discharge from ED or hospital

Proportion of children with outpatient telephone contact within 7 days after discharge from emergency room

Inclusion Criteria: Any respiratory symptom defined as tachypnea, shortness of breath, apnea, wheezing, cough, rhinitis, croup, sneezing, ear ache, or sore throat AND/OR Fever > 38.0 C Exclusion Criteria: Need of resuscitation at emergency room Need of immediate transfer to pediatric intensive care unit

Anonymized data will be shared according to the practice in place at the time of the study completion.

Mattila S, Paalanne N, Honkila M, Pokka T, Tapiainen T. Effect of Point-of-Care Testing for Respiratory Pathogens on Antibiotic Use in Children: A Randomized Clinical Trial. JAMA Netw Open. 2022 Jun 1;5(6):e2216162. doi: 10.1001/jamanetworkopen.2022.16162.