University of Oulu

Mattila S, Paalanne N, Honkila M, Pokka T, Tapiainen T. Effect of Point-of-Care Testing for Respiratory Pathogens on Antibiotic Use in Children: A Randomized Clinical Trial. JAMA Netw Open. 2022;5(6):e2216162. doi:10.1001/jamanetworkopen.2022.16162

Effect of point-of-care testing for respiratory pathogens on antibiotic use in children : a randomized clinical trial

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Author: Mattila, Suvi1,2; Paalanne, Niko1,2; Honkila, Minna1,2;
Organizations: 1Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
2PEDEGO (Pediatrics, Dermatology, Gynecology, Obstetrics) Research Unit and Medical Research Centre Oulu, University of Oulu, Oulu, Finland
3Biocenter Oulu, University of Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.9 MB)
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Language: English
Published: American Medical Association, 2022
Publish Date: 2022-09-12


Importance: Limited data are available on the clinical impact of multiplex polymerase chain reaction (PCR) point-of-care testing for respiratory pathogens in acutely ill children.

Objective: To evaluate the effect of multiplex PCR point-of-care testing for respiratory pathogens on antibiotic use in acutely ill children.

Design, Setting, and Participants: This unblinded, randomized clinical trial was conducted from May 6, 2019, through March 12, 2020. The participants were followed up until hospitalization or discharge from the emergency department (ED) for primary outcome. The study was conducted at the pediatric ED of Oulu University Hospital, Finland. Eligible study participants were children aged 0 to 17 years with fever and/or any respiratory signs or symptoms. Children with underlying medical conditions were included. The statistical analyses were performed between August 11, 2020, and September 14, 2021.

Interventions: The participants were randomly assigned in a 2:1 ratio either to undergo multiplex PCR point-of-care testing (18 respiratory viruses and 3 bacteria with results ready within 70 minutes) upon arrival at the ED or to receive routine care.

Main Outcomes and Measures: The primary outcome was the proportion of children receiving antibiotic therapy. The secondary outcomes were the numbers of diagnostic tests and radiographic imaging procedures performed and costs.

Results: A total of 1417 children were assessed for eligibility. After exclusions, 1243 children (692 boys [56%]) were randomly allocated to either the intervention (829 children) or control (414 children) group. The mean (SD) age of the participants was 3.0 (3.6) years in the intervention group (median [IQR], 1.7 [0.4–4.1] years) and 3.0 (3.5) years (median [IQR], 1.9 [0.4–4.1] years) in the control group. Multiplex PCR point-of-care testing for respiratory pathogens did not reduce the overall prescribing of antibiotics in the emergency department (226 children [27.3%] in the intervention group vs 118 children [28.5%] in the control group; risk ratio, 0.96; 95% CI, 0.79–1.16). Targeted antibiotic therapy was started in 12 children (1.4%) tested with point-of-care multiplex PCR and 2 children (0.5%) in the control group (risk ratio, 3.0; 95% CI, 0.76–11.9). The numbers of diagnostic tests did not differ between the groups, nor did the costs.

Conclusions and Relevance: In this randomized clinical trial, point-of-care testing for respiratory pathogens did not reduce the use of antibiotics at the pediatric ED. Testing for respiratory pathogens appears to have a limited impact on clinical decision-making for acutely ill children.

Trial Registration: Identifier: NCT03932942

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Series: JAMA network open
ISSN: 2574-3805
ISSN-E: 2574-3805
ISSN-L: 2574-3805
Volume: 5
Issue: 6
Article number: e2216162
DOI: 10.1001/jamanetworkopen.2022.16162
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
3121 General medicine, internal medicine and other clinical medicine
Funding: The study was supported by the Alma och K. A. Snellman Foundation (grant to Dr Mattila), the Finnish Medical Foundation (grant to Dr Mattila), the Finnish Pediatric Research Foundation (grant to Drs Mattila and Tapiainen), and Academy of Finland (grant to Dr Tapiainen).
Copyright information: © 2022 Mattila S et al. JAMA Network Open. This is an open access article distributed under the terms of the CC-BY License.