Assignment(3–4 pages, not including title and reference pages in APA format) Please read the directions for this assignment under week 3 in your course. This is a formal paper. Assignment Option 1: Ad

Rapid Influenza Testing in Children and Adults

Matthew Laird

Walden University

NURS 6512 Advanced Health Assessment

Dr. Harris

December 9, 2019

Introduction

Influenza is a leading infectious cause of morbimortality worldwide. Annually, about 5 to 10% of adults and 20 to 30% of children have symptoms of influenza-like illness (ILI), and approximately 650,000 deaths secondary to influenza occur each epidemic season (World Health Organization 2018).

Purpose Statement

The purpose of this paper is to evaluate the use, efficacy, and limitations of Rapid Influenza Diagnostic Tests (RIDTs). Through incorporation of RIDT technology into practice, this paper will analyze the benefits and strategies Advanced Practice Registered Nurses can utilize when faced with a patient presenting with influenza symptoms.

Rapid influenza diagnostic tests (RIDTs) are used in healthcare to detect the presence of the influenza virus. A nasopharyngeal swab is used for patients between neonate and adult populations. Three digital RIDTs used today are BUDDI, Sofia Influenza A+B Fluorescence Immunoassay, Veritor System Flu A+B assay. In a research study, Sofia showed the highest sensitivity for influenza A and B detection. BUDDI and Veritor showed higher detection sensitivity than a conventional RIDT for influenza A detection, but similar results for influenza B detection (Ryu, S., et al, n.d.).

RIDTs are immunoassays that can identify the presence of influenza A and B viral nucleoprotein antigens in respiratory specimens and display the result in a qualitative way (positive vs. negative). RIDTs do not include rapid molecular assays that have higher sensitivity to detect influenza viruses in respiratory specimens compared to RIDTs (Centers for Disease Control and Prevention, 2019).

Sensitivity is demonstrated by the number of positive tests results in the presence of true influenza cases. Specificity is demonstrated by the number of negative test results in the absence of true influenza cases (Gunder, L. M., & Dadig, B. A., 2009). The sensitivity of rapid flu assays varies between 70-75% (Gunder, L. M., & Dadig, B. A., 2009). The predictive value of a test takes into account the overall prevalence of the disease. When a high percentage of patients with clinical signs and symptoms of influenza also test positive for influenza by the rapid test method, the test has a high positive predictive value. During periods of influenza outbreak, the positive predictive value of rapid flue testing is highest (Gavin, P., Thomson R. (2003).

RIDTs utilizing viral antigen detection are much more commonly performed in the outpatient setting because results are provided more quickly and before the end of the visit. False positive and false-negative RT-PCR assays are relatively rare. Laboratory confirmation of influenza is not needed to initiate treatments with antiviral medications.

Groups that should be offered antiviral treatment include: Any child hospitalized with presumed influenza or possible complication or progression of influenza, any child with presumed influenza and at high risk of complication, any healthy child with presumed influenza, and a healthy child with presumed influenza who lives with a child aged younger than 6 mo or anyone at increased risk of a complication of influenza (BASS III, P. F., 2018).

When assessing a patient for influenza, providers must assess if the patient is exhibiting signs and symptoms suggestive of influenza, including atypical clinical presentation, or findings suggestive of complication s associated with influenza. If the patient is and being admitted to the hospital, the patient should be tested and begin treatment immediately. If no signs are exhibited, influenza testing is probably not indicated, and other etiologies should be considered.

The economic benefit of incorporating use of rapid PCR-based influenza testing for ED patients at risk of developing influenza-related complications depends on influenza prevalence; treatment guided by physician diagnosis or rapid testing, and treatment of all patients is more effective and less costly than no treatment (Dugas, A. F., Coleman, S., Gaydos, C. A., Rothman, R. E., & Frick, K. D., 2013).

As the influenza virus mimics bacterial infections, utilizing RITD testing additionally benefits patients by not over prescribing antibiotics to patients who would otherwise not benefit from them. In one study enrolled patients were administered a structured questionnaire, physical examination, and nasal/nasopharyngeal sampling for rapid influenzaA/B testing. Influenza test results were released only during phase 2 (January-October 2014). The proportion positive for influenza was 46.5% in phase 1 and 28.6% in phase 2, P < 0.001. Between phases, antibiotic prescriptions decreased from 81.3% to 69.3% (P = 0.001) among all patients and from 83.7% to 62.3% (P = 0.001) among influenza-positive patients. On multivariable analysis, a positive influenza result during phase 2 was associated with lower odds of antibiotic prescriptions (OR = 0.50, 95% CI = 0.26-0.95). This prospective study suggests that providing access to rapid influenza testing may reduce unnecessary antibiotic prescriptions in resource-limited settings (Tillekeratne, L., 2015).

Summary

Influenza is an annual global epidemic affecting hundreds of thousands of people. With the advancement of RIDT, rapid intervention can assist detecting influenza, saving lives, and preventing suffering. RIDT testing is appropriate during flu season and anytime Advance Practice Registered Nurses suspect influenza as a source of the patients they see to provide the highest quality care.

References

BASS III, P. F. (2018). Is it the flu? When and how to use rapid testing for

influenza. Contemporary Pediatrics, 35(3), 15–20. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=rzh&AN=128325172&site=eds-live&scope=site

Centers for Disease Control and Prevention (2019), Rapid Influenza Diagnostic Tests, Retrieved

December 9, 2019, from: https://www.cdc.gov/flu/professionals/diagnosis/clinician_guidance_ridt.htm

Dugas, A. F., Coleman, S., Gaydos, C. A., Rothman, R. E., & Frick, K. D. (2013). Cost-Utility of

Rapid Polymerase Chain Reaction-Based Influenza Testing for High-Risk Emergency Department Patients. Annals of Emergency Medicine, 62(1), 80–88. https://doi-org.ezp.waldenulibrary.org/10.1016/j.annemergmed.2013.01.005

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Gunder, L. M., & Dadig, B. A. (2009). Rapid Flu Testing. Clinician Reviews, 2(4), 4–8.

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Ryu, S. W., Suh, I. B., Ryu, S.-M., Shin, K. S., Kim, H.-S., Kim, J., … Lee, J.-H. (n.d.).

Comparison of three rapid influenza diagnostic tests with digital readout systems and one conventional rapid influenza diagnostic test. JOURNAL OF CLINICAL LABORATORY ANALYSIS, 32(2). https://doi-org.ezp.waldenulibrary.org/10.1002/jcla.22234

Tillekeratne, L., Bodinayake, C., Nagahawatte, A., Vidanagama, D., Devasiri, V.,

Arachchi, W. Woods, C. (2015). Use of Rapid Influenza Testing to Reduce Antibiotic Prescriptions Among Outpatients with Influenza-Like Illness in Southern Sri Lanka. The American Journal Of Tropical Medicine And Hygiene, 93(5), 1031–1037. https://doi-org.ezp.waldenulibrary.org/10.4269/ajtmh.15-0269

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Influenza (Seasonal) Available from: https://www.who.int/news

room/fact-sheets/detail/influenza-(seasonal), Accessed: 29 July 2019.

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