Rapid diagnosis of influenza infection in older adults: Influence on clinical care in a routine clinical setting

Background: Laboratory diagnosis of influenza has previously relied on viral isolation in culture. Rapid antigen tests (RATs) are now available but few studies have examined their use in older adults under routine clinical conditions. Objectives: To determine the utility of the RAT in older adults presenting to a large medical center and how test results impacted clinical care. Study design: Retrospective chart review of patients tested for influenza during the 2003-2004 and 2004-2005 influenza seasons. Clinical data were correlated with the results of laboratory testing. Results: Eighty-four adults tested positive for influenza. Adding the results of the RAT to symptom complexes predictive of influenza significantly enhanced the ability to diagnose influenza in the acute setting. The positive predictive value of fever plus cough increased from 32% to 92% with a positive RAT. The RAT also directed appropriate antiviral therapy. 20/22 (91%) patients with a positive RAT and symptoms <= 48 h received antiviral treatment compared to only 1/12 (8%) patients with a negative RAT and a positive culture. Conclusions: Under routine clinical conditions rapid influenza testing enhances the ability to quickly diagnose influenza and can be used to guide early treatment decisions in older adults. (c) 2008 Elsevier B.V. All rights reserved.