A multicenter randomized control trial: Point‐of‐care syndromic assessment versus standard testing in urgent care center patients with acute respiratory illness
Abstract Objective Syndromic assessment with multiplex polymerase chain reaction (mPCR) testing in patients with acute respiratory illness (ARI) allows for simultaneous identification of multiple possible infectious etiologies. Point‐of‐care (POC) syndromic assessment can be conducted in a clinical...
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Elsevier
2024-10-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.13306 |
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| author | Andrew C. Meltzer Aditya Loganathan Seamus Moran Soroush Shahamatdar Luis W. Dominguez Joel Willis Wei Zhang Xinyi Zhang Yan Ma |
| author_facet | Andrew C. Meltzer Aditya Loganathan Seamus Moran Soroush Shahamatdar Luis W. Dominguez Joel Willis Wei Zhang Xinyi Zhang Yan Ma |
| author_sort | Andrew C. Meltzer |
| collection | DOAJ |
| description | Abstract Objective Syndromic assessment with multiplex polymerase chain reaction (mPCR) testing in patients with acute respiratory illness (ARI) allows for simultaneous identification of multiple possible infectious etiologies. Point‐of‐care (POC) syndromic assessment can be conducted in a clinical setting, such as an urgent care center (UCC), without requiring certified laboratories. The primary objective of this study was to determine whether POC syndromic assessment improved patient satisfaction for patients seen at an UCC with ARI; secondary objectives included whether syndromic assessment reduced self‐isolation time, increased diagnostic confidence, and reduced overall antibiotic utilization. Methods We conducted an unblinded multicenter randomized controlled trial on UCC patients with an ARI. Patients were randomized to either SC (defined as standard UCC testing for ARI) or syndromic assessment with POC mPCR. Patients were surveyed for patient satisfaction, self‐isolation plans, diagnostic confidence, and overall antibiotic utilization. Results Among the 360 patients enrolled, those in the syndromic assessment group were more satisfied with the time required to communicate the results (98.4% vs. 42.4%, p < 0.001) on day of treatment, more likely to resume normal activities sooner (83.3% vs. 69.4%, p = 0.039), and more confident in their illness cause (60.7% vs. 29.6%, p < 0.001); however, the rate of antibiotic utilization did not differ (33.5% vs. 26%, p = 1.0). Conclusion In conclusion, our study provides evidence supporting the use of syndromic assessment in UCCs for ARI diagnosis, including patient‐centered outcomes such as greater confidence in diagnosis and more efficient isolation strategies. This study did not show a difference in more clinically oriented outcomes, such as a change in antibiotic utilization. Future studies should identify clinical care pathways to improve antibiotic stewardship for likely viral syndromes and whether the increased initial cost of syndromic assessment is offset by the clinical benefits and subsequent cost savings. |
| format | Article |
| id | doaj-art-45e63161bbc945659fcddac339b11e2d |
| institution | Kabale University |
| issn | 2688-1152 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-45e63161bbc945659fcddac339b11e2d2025-08-20T03:36:11ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522024-10-0155n/an/a10.1002/emp2.13306A multicenter randomized control trial: Point‐of‐care syndromic assessment versus standard testing in urgent care center patients with acute respiratory illnessAndrew C. Meltzer0Aditya Loganathan1Seamus Moran2Soroush Shahamatdar3Luis W. Dominguez4Joel Willis5Wei Zhang6Xinyi Zhang7Yan Ma8Department of Emergency Medicine The George Washington University School of Medicine and Health Sciences Washington District of Columbia USADepartment of Emergency Medicine The George Washington University School of Medicine and Health Sciences Washington District of Columbia USADepartment of Emergency Medicine The George Washington University School of Medicine and Health Sciences Washington District of Columbia USADepartment of Emergency Medicine The George Washington University School of Medicine and Health Sciences Washington District of Columbia USADepartment of Emergency Medicine The George Washington University School of Medicine and Health Sciences Washington District of Columbia USADepartment of Emergency Medicine The George Washington University School of Medicine and Health Sciences Washington District of Columbia USADepartment of Mathematics and Statistics University of Arkansas Little Rock Little Rock Arkansas USADepartment of Biostatistics University of Pittsburgh School of Public Health Pittsburgh Pennsylvania USADepartment of Biostatistics University of Pittsburgh School of Public Health Pittsburgh Pennsylvania USAAbstract Objective Syndromic assessment with multiplex polymerase chain reaction (mPCR) testing in patients with acute respiratory illness (ARI) allows for simultaneous identification of multiple possible infectious etiologies. Point‐of‐care (POC) syndromic assessment can be conducted in a clinical setting, such as an urgent care center (UCC), without requiring certified laboratories. The primary objective of this study was to determine whether POC syndromic assessment improved patient satisfaction for patients seen at an UCC with ARI; secondary objectives included whether syndromic assessment reduced self‐isolation time, increased diagnostic confidence, and reduced overall antibiotic utilization. Methods We conducted an unblinded multicenter randomized controlled trial on UCC patients with an ARI. Patients were randomized to either SC (defined as standard UCC testing for ARI) or syndromic assessment with POC mPCR. Patients were surveyed for patient satisfaction, self‐isolation plans, diagnostic confidence, and overall antibiotic utilization. Results Among the 360 patients enrolled, those in the syndromic assessment group were more satisfied with the time required to communicate the results (98.4% vs. 42.4%, p < 0.001) on day of treatment, more likely to resume normal activities sooner (83.3% vs. 69.4%, p = 0.039), and more confident in their illness cause (60.7% vs. 29.6%, p < 0.001); however, the rate of antibiotic utilization did not differ (33.5% vs. 26%, p = 1.0). Conclusion In conclusion, our study provides evidence supporting the use of syndromic assessment in UCCs for ARI diagnosis, including patient‐centered outcomes such as greater confidence in diagnosis and more efficient isolation strategies. This study did not show a difference in more clinically oriented outcomes, such as a change in antibiotic utilization. Future studies should identify clinical care pathways to improve antibiotic stewardship for likely viral syndromes and whether the increased initial cost of syndromic assessment is offset by the clinical benefits and subsequent cost savings.https://doi.org/10.1002/emp2.13306acute respiratory illnesspoint‐of‐care testsyndromic assessmenturgent care |
| spellingShingle | Andrew C. Meltzer Aditya Loganathan Seamus Moran Soroush Shahamatdar Luis W. Dominguez Joel Willis Wei Zhang Xinyi Zhang Yan Ma A multicenter randomized control trial: Point‐of‐care syndromic assessment versus standard testing in urgent care center patients with acute respiratory illness Journal of the American College of Emergency Physicians Open acute respiratory illness point‐of‐care test syndromic assessment urgent care |
| title | A multicenter randomized control trial: Point‐of‐care syndromic assessment versus standard testing in urgent care center patients with acute respiratory illness |
| title_full | A multicenter randomized control trial: Point‐of‐care syndromic assessment versus standard testing in urgent care center patients with acute respiratory illness |
| title_fullStr | A multicenter randomized control trial: Point‐of‐care syndromic assessment versus standard testing in urgent care center patients with acute respiratory illness |
| title_full_unstemmed | A multicenter randomized control trial: Point‐of‐care syndromic assessment versus standard testing in urgent care center patients with acute respiratory illness |
| title_short | A multicenter randomized control trial: Point‐of‐care syndromic assessment versus standard testing in urgent care center patients with acute respiratory illness |
| title_sort | multicenter randomized control trial point of care syndromic assessment versus standard testing in urgent care center patients with acute respiratory illness |
| topic | acute respiratory illness point‐of‐care test syndromic assessment urgent care |
| url | https://doi.org/10.1002/emp2.13306 |
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