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Point-of-care Testing of Respiratory Pathogens at Pediatric Emergency Room

  • Clinicaltrials.gov identifier

    NCT03932942

  • Recruitment Status

    Completed

  • First Posted

    May 1, 2019

  • Last update posted

    November 4, 2020

Study Description

Brief summary:

The main objective of the trial is to evaluate the effect of point-of-care testing of respiratory pathogens at a pediatric emergency room on the antibiotic consumption and hospital admissions in acutely ill children.

  • Condition or Disease:Respiratory Tract Infections
  • Intervention/Treatment: Diagnostic Test: QIAstat at pediatric emergency room
  • Phase: N/A

Detailed Description

The study is a randomized controlled trial including children 0 up to 17 years of age with fever or acute respiratory infection at a pediatric emergency department in university hospital. In total 1668 subjects will be randomly allocated to undergo point-of-care multiplex respiratory pathogen testing with results ready within approximately one hour or to a control group with testing according to clinical judgement and results ready within next office day. Subjects will be randomized on admission and unequal allocation ratio of 2:1 (1112 subjects to intervention and 556 subjects to control arm) will be used. Data on rate of hospitalization, antibiotic prescriptions, ancillary testing and length of visit will be collected using medical record system.

Study Design

  • Study Type: Interventional
  • Actual Enrollment: 1350 participants
  • Allocation: Randomized
  • Intervention Model: Parallel Assignment
  • Intervention Model Description: Randomized controlled trial 2:1
  • Masking: None (Open Label) ()
  • Primary Purpose: Diagnostic
  • Official Title: Impact of Multiplex Respiratory Pathogen Testing on Antimicrobial Consumption and Hospital Admissions at Pediatric Emergency Room: A Randomized Controlled Trial
  • Actual Study Start Date: May 2019
  • Actual Primary Completion Date: March 2020
  • Actual Study Completion Date: April 2020

Arms and interventions

Arm Intervention/treatment
Experimental: Point-of-care testing of respiratory pathogens on admission
Point-of-care testing of respiratory pathogens on admission. The subjects will receive the point-of-care testing of respiratory pathogens at pediatric emergency room. The results are ready within 1 one hour.
Diagnostic Test: QIAstat at pediatric emergency room
Pediatric acute care nurses will obtain respiratory samples for testing from all patients with fever or any respiratory symptom.

Outcome Measures

  • Primary Outcome Measures: 1. Proportion of children with antibiotic prescription at emergency room [ Time Frame: Up to 1 day after study entry ]
    Antibiotic consumption at emergency room
  • Secondary Outcome Measures: 1. Number of other diagnostic tests than point-of-care test performed at emergency room [ Time Frame: Up to 1 day after study entry ]
    Number and cost of diagnostic tests such as blood culture, blood chemistry
  • 2. Proportion of children with outpatient telephone contact within 7 days after discharge from emergency room [ Time Frame: 0-7 days ]
    Outpatient telephone contact within 7 days after discharge from emergency room
  • 3. Proportion of children with readmission to hospital or revisit at emergency room [ Time Frame: 0-7 days after study entry ]
    Proportion of children with hospital readmission or emergency room revisit within 7 days after discharge from ED or hospital
  • 4. Proportion of children with antibiotics in one week [ Time Frame: 0-7 days after study entry ]
    Antimicrobial prescription rate
  • 5. Proportion of children receiving macrolide antibiotic at pediatric emergency room [ Time Frame: Up to 1 day after study entry ]
    Among all children randomized
  • 6. Proportion of infants aged < 3 months receiving macrolide antibiotic at pediatric emergency room [ Time Frame: Up to 1 day after study entry ]
    Among all children randomized
  • 7. Proportion of children admitted to hospital [ Time Frame: Up to 1 day after study entry ]
    Hospital admissions
  • 8. Proportion of children admitted to hospital [ Time Frame: 0-7 days after study entry ]
    Hospital admissions
  • 9. Number of diagnostic tests per child other than point-of-care test performed within one week [ Time Frame: 0-7 days after discharge ]
    Ancillary laboratory testing
  • 10. Proportion of children with admission to pediatric intensive care unit or intensive care unit [ Time Frame: 0-30 days ]
    Admission to pediatric intensive care unit or intensive care unit
  • 11. Proportion of children who died within one month after study entry [ Time Frame: 0-30 days ]
    Mortality
  • 12. Cost in euros per child per visits [ Time Frame: 0-7 days after study entry ]
    Visit associated cost (euros)
  • 13. Length of stay at emergency room in minutes [ Time Frame: Up to 1 day after study entry ]
    Mean length of visit at emergency room (minutes)
  • 14. Proportion of children receiving correct pathogen directed therapy [ Time Frame: 0-7 days after study entry ]
    Antimicrobial use for Mycoplasma pneumoniae, pertussis and influenza
  • 15. Time to initiation of correct pathogen directed therapy [ Time Frame: 0-7 days after study entry ]
    Antimicrobials for Mycoplasma pneumoniae, pertussis and influenza (minutes)

Eligibility Criteria

  • Ages Eligible for Study: up to 17 / (Birth to 17 years)
  • Sexes Eligible for Study: All
  • Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

- Any respiratory symptom defined as tachypnea, shortness of breath, apnea, wheezing,
cough, rhinitis, croup, sneezing, ear ache, or sore throat AND/OR

- Fever > 38.0 C

Exclusion Criteria:

- Need of resuscitation at emergency room

- Need of immediate transfer to pediatric intensive care unit

Contacts and Locations

Contacts

Locations

Finland
Department of Pediatrics, Oulu University Hospital
Oulu

Sponsors and Collaborators

University of Oulu

Oulu University Hospital

Investigators

Principal Investigator: Terhi S Tapiainen, MD,PhD Oulu University Hospital

More Information

  • Responsible Party: University of Oulu
  • ClinicalTrials.gov Identifier: NCT03932942 History of Changes
  • Other Study ID Numbers: EETTMK_08_2019
  • First Posted: May 1, 2019 Key Record Dates
  • Last Update Posted: November 4, 2020
  • Last Verified: November 2020
  • Individual Participant
    Data (IPD) Sharing
    Statement:

  • Plan to Share IPD: Yes
  • Plan Description: Anonymized data will be shared according to the practice in place at the time of the study completion.
  • Supporting Materials: Study Protocol, Statistical Analysis Plan (SAP), Informed Consent Form (ICF)
  • Time Frame: At the study completion or at submission
  • Access Criteria: For reviewers and editors before publishing and after publishing for the whole research community
  • Studies a U.S. FDA-regulated Drug Product: No
  • Studies a U.S. FDA-regulated Device Product: No
  • Keywords provided by University of Oulu: Respiratory pathogen
    Pediatric emergency medicine
    Cost-benefit analysis
    Point-of-care testing
    Emergency room
    Anti-bacterial agents
    Patient admission
    Pediatrics
    Antimicrobial stewardship
  • Additional relevant MeSH terms: Respiratory Tract Infections Emergencies