J Korean Med Sci.  2022 Jan;37(1):e3. 10.3346/jkms.2022.37.e3.

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

• Lee JY
• Baek SH
• Ahn JG
• Yoon SH
• Kim MK
• Kim SY
• Kim KW
• Sohn MH
• Kang JM

• KMID: 2524181
• DOI: http://doi.org/10.3346/jkms.2022.37.e3

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.

Keyword

Point-of-Care Testing; Polymerase Chain Reaction; Emergency Department; Oseltamivir; Republic of Korea

Figure

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  Fig. 1 Flowchart of included and excluded study patients.ED = emergency department, RAT = rapid antigen test, RT-PCR = real time-polymerase chain reaction, IFV = influenza virus.

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  Fig. 2 Influenza-like illness trends with rapid antigen test and monthly positivity rates.Blue bar graph indicates the total number of RAT cases with the red showing the positive cases.

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  Fig. 3 (A) TAT difference between the RAT-positive and RAT-false-negative groups. (B, C) Multivariable analysis of the clinical outcomes by TAT (≥ 12 hours and ≥ 24 hours).TAT = turnaround time to antiviral treatment, RAT = rapid antigen test, PCR = polymerase chain reaction, LRTI = lower respiratory tract infection, IFV = influenza virus, PICU = pediatric intensive care unit, OR = odds ratio, CI = confidence interval.Statistically significant P values were marked with asterisks (*P < 0.05).

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