ABSTRACT

1. Change in Physician Behavior Regarding Ordering Rapid Flu Test in Patients Hospitalized with Acute Lower Respiratory Tract Infections During Flu Season. MuraliKolikonda, MD; Daniel Curran, MD; Jorge Perez, MD; Katherine Rivera , MD; SwethaKadali, MD; Rehab Abdelfattah, MD,MPH ; Lisandra Rodriguez, MD; Arnold Forest, DO; Paula Peyrani, MD; Julio Ramirez, MD ABSTRACT MATERIALS AND METHODS, CONTINUED RESULTS • Out of 261 patients in Group A ,96 patients were ordered Rapid Flu test . • Out of 497 patients in Group B ,165 patients were ordered Rapid Flu test. • Compared to Group A , the percentage of patients ordered Rapid Flu test is significantly increased in Group B . Background Early diagnosis is important in the prevention of influenza related complications. The CDC has incorporated the use of rapid influenza diagnostic testing in their recommendations for the prevention and control of Influenza. The influence of the CDC recommendations and educational campaigns about influenza on physician behavior is unknown. The objective of this study is to describe the change in frequency of physicians ordering the Rapid flu test between 2010-2011 and 2012-2013. Materials and Methods This is a secondary data analysis of the RETOS database. This study includes patients in nine hospitals in the Louisville area. The chi-squared test was used to compare the frequency of physician ordered rapid influenza tests from the 2010-2011 flu season to the 2012-2013 flu season. Result During the 2010-2011 flu season, 96 of 261 patients had the rapid flu test ordered during their hospitalization for ALRTI [37%]. In the 2012-2013 flu season, 267 of 497 patients had the rapid flu test ordered during their hospitalization [54%]. The difference in rate of rapid flu test ordering between seasons was found to be statistically significant (P<0.001). Conclusion This study indicates that physician behavior changed regarding ordering of the rapid influenza test in patients hospitalized with ALRTI over the course of our three year study. CDC guidelines, physician knowledge and investigator presence all could have played a role in this result. Continued emphasis should be made on physician awareness of the utility of the rapid flu test in the diagnosis of influenza. • This was a secondary data analysis of the RETOS database of patients hospitalized with acute lower respiratory infections during the flu season. • The study includes patients in nine hospitals in the Louisville area. • Two Flu season study periods are selected for comparison. 1. Group A This included all patients hospitalized with acute lower respiratory tract infections during the 2010/2011 influenza season. Data on the rapid influenza test ordered by the primary physician was collected for each patient. 2. Group B This included all patients hospitalized with acute lower respiratory tract infections during the 2012/2013 influenza season. Data on the rapid influenza test ordered by the primary physician was collected for each patient. Statistical analysis The chi-squared test was used to compare the frequency of physician ordered rapid influenza tests from the 2010-2011 flu seasons to the 2012-2013 flu seasons. CONCLUSIONS • This study indicates that physician behavior changed regarding ordering the rapid influenza test in patients hospitalized with acute lower respiratory tract infections over the course of our three year study. • CDC guidelines and educational campaigns might have played a role in the documented increase. • Clinical research in the field of influenza and investigator presence in hospitals from Jefferson County may have contributed to this significant change in clinical practice. • During the last influenza season, out of all persons hospitalized with acute lower respiratory infections, 46% of the patients did not receive a diagnostic test for influenza. • Continued emphasis should be made on physician awareness of the utility of the rapid flu test in the diagnosis of influenza for all patients hospitalized with acute lower respiratory tract infections during the flu season. Figure 1: Number of patients hospitalized with acute lower respiratory infections. INTRODUCTION • In Group A, 261 patients were hospitalized with acute lower respiratory infections (Figure 1). • In Group B, a total of 497 patients were hospitalized with acute lower respiratory infections (Figure 1). • The percentage of patients in whom the rapid flu test was ordered at the time of time of hospital admission during the two study periods is depicted in Figure 2. The difference in rate of rapid flu test ordering between seasons was found to be statistically significant (P<0.001). • Influenza results in an estimated 226,000 hospitalizations and mortality ranging • from 3,000 to 49,000.[1] • • Rates of morbidity and mortality vary year to year due to differences in length • of the influenza season and virulence of virus strains. • • Early Diagnosis of Influenza is important in the clinical decision making and • prevention of complications. • • In the last flu season in the United States about 55,470 (27%) were tested positive for influenza out of 203,706 respiratory specimens tested.[2] • • Ever since the 2009 pandemic, influenza has become a major health concern • and the Centers for Disease Control and Prevention (CDC) have incorporated an • algorithm for the usage of rapid influenza diagnostic tests in their • recommendations for the prevention and control of Influenza.[3] • • The rapid flu test is considered to be one of the most common initially ordered tests during the flu season in persons suffering with acute lower respiratory tract infections. • • The influence of CDC recommendations and educational campaigns about • influenza on physician behavior is unknown. • • The objective of this study is to describe the change in frequency of physicians • ordering the rapid flu test between 2010-2011 and 2012-2013 influenza seasons. REFERENCES Thompson MG et al. Updated Estimates of Mortality Associated with Seasonal Influenza through the 2006-2007 Influenza Season. MMWR 2010; 59(33): 1057-1062. CDC update: Influenza Activity — United States, September 30, 2012– February 9, 2013,WeeklyFebruary 22, 2013 /MMRW 2013;62(07);124- 130 Centers for Disease Control and Prevention (CDC). Evaluation of rapid influenza diagnostic tests for detection of novel influenza A (H1N1) Virus—United States, 2009. MMWR Morb Mortal Wkly Rep. 2009 Aug 7;58(30):826-9. RESULTS Figure 2: percentage of patients ordered Rapid flu among those hospitalized with acute lower respiratory tract infections.