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Delayed Influenza Treatment in Children With False-Negative Rapid Antigen Test: A Retrospective Single-Center Study in Korea 2016-2019

Authors
 Ji Young Lee  ;  Seung Hwan Baek  ;  Jong Gyun Ahn  ;  Seo Hee Yoon  ;  Moon Kyu Kim  ;  Soo Yeon Kim  ;  Kyung Won Kim  ;  Myung Hyun Sohn  ;  Ji-Man Kang 
Citation
 JOURNAL OF KOREAN MEDICAL SCIENCE, Vol.37(1) : e3, 2022-01 
Journal Title
JOURNAL OF KOREAN MEDICAL SCIENCE
ISSN
 1011-8934 
Issue Date
2022-01
MeSH
Antigens, Viral / blood ; Antiviral Agents / therapeutic use* ; Child ; Child, Preschool ; Cost-Benefit Analysis ; False Negative Reactions ; Female ; Humans ; Infant ; Influenza, Human / blood ; Influenza, Human / diagnosis* ; Influenza, Human / drug therapy* ; Influenza, Human / economics ; Male ; Orthomyxoviridae / immunology ; Republic of Korea ; Retrospective Studies ; Time-to-Treatment*
Keywords
Emergency Department ; Oseltamivir ; Point-of-Care Testing ; Polymerase Chain Reaction ; Republic of Korea
Abstract
Background: We aimed to examine the delay in antiviral initiation in rapid antigen test (RAT) false-negative children with influenza virus infection and to explore the clinical outcomes. We additionally conducted a medical cost-benefit analysis.

Methods: This single-center, retrospective study included children (aged < 10 years) with influenza-like illness (ILI), hospitalized after presenting to the emergency department during three influenza seasons (2016-2019). RAT-false-negativity was defined as RAT-negative and polymerase chain reaction-positive cases. The turnaround time to antiviral treatment (TAT) was from the time when RAT was prescribed to the time when the antiviral was administered. The medical cost analysis by scenarios was also performed.

Results: A total of 1,430 patients were included, 7.5% were RAT-positive (n = 107) and 2.4% were RAT-false-negative (n = 20). The median TAT of RAT-false-negative patients was 52.8 hours, significantly longer than that of 4 hours in RAT-positive patients (19.2-100.1, P < 0.001). In the multivariable analysis, TAT of ≥ 24 hours was associated with a risk of severe influenza infection and the need for mechanical ventilation (odds ratio [OR], 6.8, P = 0.009 and OR, 16.2, P = 0.033, respectively). The medical cost varied from $11.7-187.3/ILI patient.

Conclusion: Antiviral initiation was delayed in RAT-false-negative patients. Our findings support the guideline that children with influenza, suspected of having severe or progressive infection, should be treated immediately.
Files in This Item:
T202201303.pdf Download
DOI
10.3346/jkms.2022.37.e3
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Ji-Man(강지만) ORCID logo https://orcid.org/0000-0002-0678-4964
Kim, Kyung Won(김경원) ORCID logo https://orcid.org/0000-0003-4529-6135
Kim, Moon Kyu(김문규) ORCID logo https://orcid.org/0000-0001-6186-3991
Kim, Soo Yeon(김수연) ORCID logo https://orcid.org/0000-0003-4965-6193
Baek, Seung Hwan(백승환)
Sohn, Myung Hyun(손명현) ORCID logo https://orcid.org/0000-0002-2478-487X
Ahn, Jong Gyun(안종균) ORCID logo https://orcid.org/0000-0001-5748-0015
Yoon, Seo Hee(윤서희) ORCID logo https://orcid.org/0000-0002-8361-9815
Lee, Ji Young(이지영)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/188482
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