Case study

Case study

 

Assignment Option 1: Adult Assessment Tools or Diagnostic Tests:

1. Rapid Influenza testing in children and adults.
Include following:
A description of how the assessment tool or diagnostic test you were assigned is used in health care.
What is its purpose?
How is it conducted?
What information does it gather?
Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.

 

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Solution

Utilization of the rapid influenza testing in Healthcare

The rapid influenza testing tool is referred to as the rapid influenza diagnostic tests (RIDTs), which is a testing tool that can be able to detect the presence of influenza type A or type B in different respiratory specimens and eventually display the results in a qualitative way which is either positive or negative(Tanei et al., 2014). As an immunoassay, the (RIDTS) detect the nuclear protein antigens of influenza type A or B in different respiratory specimens. The RIDTS is therefore used as the first test for influenza, with the laboratory confirmation of influenza virus being needed through the viral culture or reverse transcription-polymerase chain reaction RT-PCR. Rapid influenza tests can therefore be able to produce results in a clinically-relevant time frame which is normally less than 15 minutes (Tanei et al., 2014).

Normally the rapid influenza test is therefore used to make treatment and diagnostic decisions for different patients in clinical settings, such as whether a healthcare practitioner should prescribe certain medications to patients or not. However, despite its use in clinical settings, the RIDTS possesses limited sensitivity in the detection of influenza viruses in different specimens compared to the RT-PCR test (Chartrand et al., 2018). Negative results from the rapid influenza test should therefore not be used to exclude influenza in a patient, especially if the patient is displaying the symptoms and signs suggestive of influenza. In healthcare settings, healthcare practitioners do not withhold any antiviral treatment for patients who are suspected of having influenza even though their RIDT tests are negative. For influenza, testing is normally needed among patients with false-negative results but who continue to display symptoms of influenza (Seki et al., 2020).

Rapid influenza testing is also utilized in detecting influenza virus outbreaks in different settings such as schools, chronic care facilities, hospitals, and nursing homes. A positive rapid influenza test can therefore support the implementation of control and prevention measures for influenza outbreaks (Tanei et al., 2014). However, even during the use of influenza tests for public health services, negative RIDT tests will not include the presence of influenza viruses in a given population, especially if symptoms of influenza can be easily noticed in target populations (Seki et al., 2020).

Validity and Reliability of Rapid Influenza Testing

The rapid influenza test (RIDT) has numerous validity and reliability issues. One of the central reliability and validity issues related to the RIDT is a positive result or a negative result. A positive result will therefore occur when an RIDT is able to detect a viral antigen in a patient while such an influenza virus may not be present in a given patient or be contagious (Chartrand et al., 2018). The positive predictive value over rapid influenza tests will therefore be significantly higher if influenza activity is high in the community being tested. In the use of the rapid influenza test, a positive result will therefore be a true positive if such a test was conducted close to the onset of the influenza illness, which is normally within four days (Tanei et al., 2014). A positive result of the rapid influenza test will also be a true positive if there’s high influenza activity in a given population or during seasons of high influenza activity.  In contrast, a positive predictive value of the rapid influenza test will be lowest if the activity of influenza is low in the population being tested or during low influenza symptoms. The positive result will significantly affect the reliability and validity of the RIDT (Tanei et al., 2014).

 

On the other hand, a false negative result is also a significant issue in the utilization of influenza tests. A false negative result which infers a negative predictive value, will therefore be highest if influenza is low in the target population (Chartrand et al., 2018). In the use of the rapid influenza test, a negative result will most likely be a true negative if there is no influenza activity in the target population and if the respiratory specimens that were evaluated were collected close to the onset of the illness (Seki et al., 2020). False-negative results are therefore more likely to occur when influenza activity is high in a test population (Chartrand et al., 2018).

Scholarly studies have therefore highlighted that the sensitivity of the RIDT will be approximately 50 to 70%. The low sensitivity of the RIDT makes the tool to be unreliable for accurate detection of influenza among patients, with RT-PCR tests being needed for confirmation among already tested patients (Chartrand et al., 2018). On the other hand, the specificities of RIDTS is approximately90 to 95%, which means that false-negative resource will be more common than false-positive results. Considering the sensitivity and specificity of the rapid influenza test, negative results of such tests will not exclude the presence of influenza virus infection completely. Influenza should still be considered among patient who shows symptoms, signs, and history of influenza. Different strategies to improve the reliability and validity of rapid influenza test includes collecting specimens during early days of illness as possible and following up negative results with RT PCR test for confirmation in a laboratory(Tanei et al., 2014).

 

References

Chartrand, C., Leeflang, M. M., Minion, J., Brewer, T., & Pai, M. (2018). Accuracy of Rapid Influenza Diagnostic Tests. Annals of Internal Medicine, 156(7), 500. https://doi.org/10.7326/0003-4819-156-7-201204030-00403

Seki, Y., Oda, Y., & Sugaya, N. (2020). Very high sensitivity of a rapid influenza diagnostic test in adults and elderly individuals within 48 hours of the onset of illness. PLOS ONE, 15(5), e0231217. https://doi.org/10.1371/journal.pone.0231217

Tanei, M., Yokokawa, H., Murai, K., Sakamoto, R., Amari, Y., Boku, S., Inui, A., Fujibayashi, K., Uehara, Y., Isonuma, H., Kikuchi, K., & Naito, T. (2014). Factors influencing the diagnostic accuracy of the rapid influenza antigen detection test (RIADT): a cross-sectional study. BMJ Open, 4(1), e003885. https://doi.org/10.1136/bmjopen-2013-003885

 

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