Molecular Point-of-care Testing for Influenza and Other Respiratory Viruses

Respiratory virus infection is a common cause of hospitalisation in adults. New rapid molecular test platforms produce results faster than standard laboratory PCR and are deployable as point-of-care tests (POCT). POC testing has the potential to improve clinical care, but there is a lack of high quality evidence to support its use.

We performed a pragmatic randomised controlled trial enrolling adults presenting to a large UK hospital with acute respiratory illness (ARI). Patients were randomly assigned (1:1) to receive a molecular POCT for respiratory viruses or routine clinical care. The primary outcome was the proportion of patients who received antibiotics whist hospitalised. Secondary outcomes included; duration of antibiotics, length of stay, antiviral use, isolation facility use, and safety. 

720 patients were randomised (362 to POCT and 358 to routine care). There was no difference in the primary outcome but antibiotic treated patients in the POCT group more frequently received single doses or brief courses of antibiotics. Length of stay was shorter in the POCT group and appropriate antiviral treatment and isolation of influenza positive patients was more common in the POCT group. 
Routine use of a molecular POCT strategy for respiratory viruses was associated with improvements in antibiotic use, length of stay, influenza detection and antiviral use, isolation facility use and appeared to be safe.