Article in Japanese

Analysis of clinical predictive rate compared with antigen-based rapid diagnostic assays for respiratory infectious pathogens in a pediatric department

Haruka TAKEI^1,2), Naruhiko ISHIWADA^3,4), Naoki TAKEMOTO¹⁾, Yutaka KITANI¹⁾, Junichi SATO¹⁾, Naoki SHIMOJO²⁾

Background: Antigen detection kits are often used for rapid point-of-care diagnosis of infectious diseases. However, these tests are sometimes unnecessary. We examined clinical predictive rates to determine appropriate or inappropriate use of antigen detection kits.
Method: Between April 2016 and March 2017, the results of rapid antigen detection testing for influenza virus, adenovirus, Streptococcus pyogenes, Mycoplasma pneumoniae, respiratory syncytial virus, and human metapneumovirus were analyzed. Ten pediatricians recorded their predictions of the test results (using a 4-point scale) and the reasons for their predictions. We calculated predictive rates based on the rates of consistency with the test results.
Results: We analyzed 209 records. Negative results were predicted for nearly half of the tests. The clinical predictive rate was 0.74, the positive predictive rate was 0.60, and the negative predictive rate was 0.89. Epidemic history showed concordance between predictions and test results.
Conclusion: The negative predictive rate was high, and negative predicted results before testing accounted for nearly half of all cases in the current study. Negative test results for certain inpatient infections sometimes require confirmation; however, rapid antigen detection kits are not necessarily needed for confirmation of negative results in nonepidemic infectious diseases, particularly in outpatient care, because of high negative clinical predictive rate.

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1) Department of Pediatrics, Funabashi Municipal Medical Center
2) Department of Pediatrics, Chiba University Graduate School of Medicine
3) Department of Infectious Diseases, Medical Mycology Research Center, Chiba University
4) Department of Pediatrics, Goi Hospital

Key words	rapid antigen detection kits, predictive value, appropriate use of test, Choosing wisely
Received	January 29, 2018
Accepted	September 10, 2018

31 (1)：7─12,2019