Availability and use of rapid diagnostic tests for the management of acute childhood infections in Europe: A cross-sectional survey of paediatricians

Juan Emmanuel Dewez; Lucy Pembrey; Ruud G. Nijman; Stefano del Torso; Zachi Grossman; Adamos Hadjipanayis; Diego van Esso; Emma Lim; Marieke Emonts; James Burns; Christèle Gras-LeGuen; Daniela Kohlfuerst; Hans J. rgen Dornbusch; Karen Brengel-Pesce; Francois Mallet; Ulrich von Both; Maria Tsolia; Irini Eleftheriou; Dace Zavadska; Ronald de Groot; Michiel van der Flier; Henriëtte Moll; Nienke Hagedoorn; Dorine Borensztajn; Rianne Oostenbrink; Taco Kuijpers; Marko Pokorn; Katarina Vincek; Federico Martinó n-Torres; Irene Rivero; Philipp Agyeman; Enitan D. Carrol; Stéphane Paulus; Aubrey Cunnington; Jethro Herberg; Michael Levin; Aida Mujkić; Karin Geitmann; Liviana da Dalt; Arunas Valiulis; Risto Lapatto; Garyfallia Syridou; P. ter Altorjai; Paul Torpiano; Ketil Størdal; K. roly Illy; Artur Mazur; Mateja Vintar Spreitzer; Joana Rios; Corinne Wyder; Ivanna Romankevych; Romain Basmaci; Salvador Ibanez-Mico; Shunmay Yeung

doi:https://doi.org/10.1371/journal.pone.0275336

Availability and use of rapid diagnostic tests for the management of acute childhood infections in Europe: A cross-sectional survey of paediatricians

Juan Emmanuel Dewez, Lucy Pembrey, Ruud G. Nijman, Stefano del Torso, Zachi Grossman, Adamos Hadjipanayis, Diego van Esso, Emma Lim, Marieke Emonts, James Burns, Christèle Gras-LeGuen, Daniela Kohlfuerst, Hans J. rgen Dornbusch, Karen Brengel-Pesce, Francois Mallet, Ulrich von Both, Maria Tsolia, Irini Eleftheriou, Dace Zavadska, Ronald de GrootMichiel van der Flier, Henriëtte Moll, Nienke Hagedoorn, Dorine Borensztajn, Rianne Oostenbrink, Taco Kuijpers, Marko Pokorn, Katarina Vincek, Federico Martinó n-Torres, Irene Rivero, Philipp Agyeman, Enitan D. Carrol, Stéphane Paulus, Aubrey Cunnington, Jethro Herberg, Michael Levin, Aida Mujkić, Karin Geitmann, Liviana da Dalt, Arunas Valiulis, Risto Lapatto, Garyfallia Syridou, P. ter Altorjai, Paul Torpiano, Ketil Størdal, K. roly Illy, Artur Mazur, Mateja Vintar Spreitzer, Joana Rios, Corinne Wyder, Ivanna Romankevych, Romain Basmaci, Salvador Ibanez-Mico, Shunmay Yeung

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background Point-of-care-tests (POCTs) have been advocated to optimise care in patients with infections but their actual use varies. This study aimed to estimate the variability in the adoption of current POCTs by paediatricians across Europe, and to explore the determinants of variability. Methods and findings A cross-sectional survey was conducted of hospital and primary care paediatricians, recruited through professional networks. Questions focused on the availability and use of currently available POCTs. Data were analysed descriptively and using Median Odds Ratio (MOR) to measure variation between countries. Multilevel regression modelling using changes in the area under the receiver operating characteristic curve of models were used to assess the contribution of individual or workplace versus country level factors, to the observed variation. The commonest POCT was urine dipsticks (UD) which were available to >80% of primary care and hospital paediatricians in 68% (13/19) and 79% (23/29) countries, respectively. Availability of all POCTs varied between countries. In primary care, the country (MOR) varied from 1.61 (95%CI: 1.04-2.58) for lactate to 7.28 (95%CI: 3.04-24.35) for UD. In hospitals, the country MOR varied from 1.37 (95%CI:1.04-1.80) for lactate to 11.93 (95% CI:3.35-72.23) for UD. Most paediatricians in primary care (69%, 795/1154) and hospital (81%, 962/1188) would use a diagnostic test in the case scenario of an infant with undifferentiated fever. Multilevel regression modelling showed that the country of work was more important in predicting both the availability and use of POCTs than individual or workplace characteristics. Conclusion There is substantial variability in the adoption of POCTs for the management of acute infections in children across Europe. To inform future implementation of both existing and innovative tests, further research is needed to understand what drives the variation between countries, the needs of frontline clinicians, and the role of diagnostic tests in the management of acute childhood infections.

Original language	English
Article number	e0275336
Journal	PLOS ONE
Volume	17
Issue number	12 December
DOIs	https://doi.org/10.1371/journal.pone.0275336
Publication status	Published - 1 Dec 2022

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Dewez, J. E., Pembrey, L., Nijman, R. G., del Torso, S., Grossman, Z., Hadjipanayis, A., van Esso, D., Lim, E., Emonts, M., Burns, J., Gras-LeGuen, C., Kohlfuerst, D., Dornbusch, H. J. R., Brengel-Pesce, K., Mallet, F., von Both, U., Tsolia, M., Eleftheriou, I., Zavadska, D., ... Yeung, S. (2022). Availability and use of rapid diagnostic tests for the management of acute childhood infections in Europe: A cross-sectional survey of paediatricians. PLOS ONE, 17(12 December), Article e0275336. https://doi.org/10.1371/journal.pone.0275336

@article{69d9ba5ac7ad4042ab5f5ebbceb28b68,

title = "Availability and use of rapid diagnostic tests for the management of acute childhood infections in Europe: A cross-sectional survey of paediatricians",

abstract = "Background Point-of-care-tests (POCTs) have been advocated to optimise care in patients with infections but their actual use varies. This study aimed to estimate the variability in the adoption of current POCTs by paediatricians across Europe, and to explore the determinants of variability. Methods and findings A cross-sectional survey was conducted of hospital and primary care paediatricians, recruited through professional networks. Questions focused on the availability and use of currently available POCTs. Data were analysed descriptively and using Median Odds Ratio (MOR) to measure variation between countries. Multilevel regression modelling using changes in the area under the receiver operating characteristic curve of models were used to assess the contribution of individual or workplace versus country level factors, to the observed variation. The commonest POCT was urine dipsticks (UD) which were available to >80% of primary care and hospital paediatricians in 68% (13/19) and 79% (23/29) countries, respectively. Availability of all POCTs varied between countries. In primary care, the country (MOR) varied from 1.61 (95%CI: 1.04-2.58) for lactate to 7.28 (95%CI: 3.04-24.35) for UD. In hospitals, the country MOR varied from 1.37 (95%CI:1.04-1.80) for lactate to 11.93 (95% CI:3.35-72.23) for UD. Most paediatricians in primary care (69%, 795/1154) and hospital (81%, 962/1188) would use a diagnostic test in the case scenario of an infant with undifferentiated fever. Multilevel regression modelling showed that the country of work was more important in predicting both the availability and use of POCTs than individual or workplace characteristics. Conclusion There is substantial variability in the adoption of POCTs for the management of acute infections in children across Europe. To inform future implementation of both existing and innovative tests, further research is needed to understand what drives the variation between countries, the needs of frontline clinicians, and the role of diagnostic tests in the management of acute childhood infections.",

author = "Dewez, {Juan Emmanuel} and Lucy Pembrey and Nijman, {Ruud G.} and {del Torso}, Stefano and Zachi Grossman and Adamos Hadjipanayis and {van Esso}, Diego and Emma Lim and Marieke Emonts and James Burns and Christ{\`e}le Gras-LeGuen and Daniela Kohlfuerst and Dornbusch, {Hans J. rgen} and Karen Brengel-Pesce and Francois Mallet and {von Both}, Ulrich and Maria Tsolia and Irini Eleftheriou and Dace Zavadska and {de Groot}, Ronald and {van der Flier}, Michiel and Henri{\"e}tte Moll and Nienke Hagedoorn and Dorine Borensztajn and Rianne Oostenbrink and Taco Kuijpers and Marko Pokorn and Katarina Vincek and {Martin{\'o} n-Torres}, Federico and Irene Rivero and Philipp Agyeman and Carrol, {Enitan D.} and St{\'e}phane Paulus and Aubrey Cunnington and Jethro Herberg and Michael Levin and Aida Mujki{\'c} and Karin Geitmann and {da Dalt}, Liviana and Arunas Valiulis and Risto Lapatto and Garyfallia Syridou and Altorjai, {P. ter} and Paul Torpiano and Ketil St{\o}rdal and Illy, {K. roly} and Artur Mazur and Spreitzer, {Mateja Vintar} and Joana Rios and Corinne Wyder and Ivanna Romankevych and Romain Basmaci and Salvador Ibanez-Mico and Shunmay Yeung",

note = "Funding Information: Funding:Thefullandcorrectlistoffundersis: EuropeanUnionHorizon2020programme;grant agreements668303and848196NationalInstitute forHealthResearch. Publisher Copyright: {\textcopyright} 2022 Dewez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2022",

month = dec,

day = "1",

doi = "https://doi.org/10.1371/journal.pone.0275336",

language = "English",

volume = "17",

journal = "PLOS ONE",

issn = "1932-6203",

publisher = "Public Library of Science",

number = "12 December",

}

Dewez, JE, Pembrey, L, Nijman, RG, del Torso, S, Grossman, Z, Hadjipanayis, A, van Esso, D, Lim, E, Emonts, M, Burns, J, Gras-LeGuen, C, Kohlfuerst, D, Dornbusch, HJR, Brengel-Pesce, K, Mallet, F, von Both, U, Tsolia, M, Eleftheriou, I, Zavadska, D, de Groot, R, van der Flier, M, Moll, H, Hagedoorn, N, Borensztajn, D, Oostenbrink, R, Kuijpers, T, Pokorn, M, Vincek, K, Martinó n-Torres, F, Rivero, I, Agyeman, P, Carrol, ED, Paulus, S, Cunnington, A, Herberg, J, Levin, M, Mujkić, A, Geitmann, K, da Dalt, L, Valiulis, A, Lapatto, R, Syridou, G, Altorjai, PT, Torpiano, P, Størdal, K, Illy, KR, Mazur, A, Spreitzer, MV, Rios, J, Wyder, C, Romankevych, I, Basmaci, R, Ibanez-Mico, S & Yeung, S 2022, 'Availability and use of rapid diagnostic tests for the management of acute childhood infections in Europe: A cross-sectional survey of paediatricians', PLOS ONE, vol. 17, no. 12 December, e0275336. https://doi.org/10.1371/journal.pone.0275336

TY - JOUR

T1 - Availability and use of rapid diagnostic tests for the management of acute childhood infections in Europe

T2 - A cross-sectional survey of paediatricians

AU - Dewez, Juan Emmanuel

AU - Pembrey, Lucy

AU - Nijman, Ruud G.

AU - del Torso, Stefano

AU - Grossman, Zachi

AU - Hadjipanayis, Adamos

AU - van Esso, Diego

AU - Lim, Emma

AU - Emonts, Marieke

AU - Burns, James

AU - Gras-LeGuen, Christèle

AU - Kohlfuerst, Daniela

AU - Dornbusch, Hans J. rgen

AU - Brengel-Pesce, Karen

AU - Mallet, Francois

AU - von Both, Ulrich

AU - Tsolia, Maria

AU - Eleftheriou, Irini

AU - Zavadska, Dace

AU - de Groot, Ronald

AU - van der Flier, Michiel

AU - Moll, Henriëtte

AU - Hagedoorn, Nienke

AU - Borensztajn, Dorine

AU - Oostenbrink, Rianne

AU - Kuijpers, Taco

AU - Pokorn, Marko

AU - Vincek, Katarina

AU - Martinó n-Torres, Federico

AU - Rivero, Irene

AU - Agyeman, Philipp

AU - Carrol, Enitan D.

AU - Paulus, Stéphane

AU - Cunnington, Aubrey

AU - Herberg, Jethro

AU - Levin, Michael

AU - Mujkić, Aida

AU - Geitmann, Karin

AU - da Dalt, Liviana

AU - Valiulis, Arunas

AU - Lapatto, Risto

AU - Syridou, Garyfallia

AU - Altorjai, P. ter

AU - Torpiano, Paul

AU - Størdal, Ketil

AU - Illy, K. roly

AU - Mazur, Artur

AU - Spreitzer, Mateja Vintar

AU - Rios, Joana

AU - Wyder, Corinne

AU - Romankevych, Ivanna

AU - Basmaci, Romain

AU - Ibanez-Mico, Salvador

AU - Yeung, Shunmay

N1 - Funding Information: Funding:Thefullandcorrectlistoffundersis: EuropeanUnionHorizon2020programme;grant agreements668303and848196NationalInstitute forHealthResearch. Publisher Copyright: © 2022 Dewez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2022/12/1

Y1 - 2022/12/1

N2 - Background Point-of-care-tests (POCTs) have been advocated to optimise care in patients with infections but their actual use varies. This study aimed to estimate the variability in the adoption of current POCTs by paediatricians across Europe, and to explore the determinants of variability. Methods and findings A cross-sectional survey was conducted of hospital and primary care paediatricians, recruited through professional networks. Questions focused on the availability and use of currently available POCTs. Data were analysed descriptively and using Median Odds Ratio (MOR) to measure variation between countries. Multilevel regression modelling using changes in the area under the receiver operating characteristic curve of models were used to assess the contribution of individual or workplace versus country level factors, to the observed variation. The commonest POCT was urine dipsticks (UD) which were available to >80% of primary care and hospital paediatricians in 68% (13/19) and 79% (23/29) countries, respectively. Availability of all POCTs varied between countries. In primary care, the country (MOR) varied from 1.61 (95%CI: 1.04-2.58) for lactate to 7.28 (95%CI: 3.04-24.35) for UD. In hospitals, the country MOR varied from 1.37 (95%CI:1.04-1.80) for lactate to 11.93 (95% CI:3.35-72.23) for UD. Most paediatricians in primary care (69%, 795/1154) and hospital (81%, 962/1188) would use a diagnostic test in the case scenario of an infant with undifferentiated fever. Multilevel regression modelling showed that the country of work was more important in predicting both the availability and use of POCTs than individual or workplace characteristics. Conclusion There is substantial variability in the adoption of POCTs for the management of acute infections in children across Europe. To inform future implementation of both existing and innovative tests, further research is needed to understand what drives the variation between countries, the needs of frontline clinicians, and the role of diagnostic tests in the management of acute childhood infections.

AB - Background Point-of-care-tests (POCTs) have been advocated to optimise care in patients with infections but their actual use varies. This study aimed to estimate the variability in the adoption of current POCTs by paediatricians across Europe, and to explore the determinants of variability. Methods and findings A cross-sectional survey was conducted of hospital and primary care paediatricians, recruited through professional networks. Questions focused on the availability and use of currently available POCTs. Data were analysed descriptively and using Median Odds Ratio (MOR) to measure variation between countries. Multilevel regression modelling using changes in the area under the receiver operating characteristic curve of models were used to assess the contribution of individual or workplace versus country level factors, to the observed variation. The commonest POCT was urine dipsticks (UD) which were available to >80% of primary care and hospital paediatricians in 68% (13/19) and 79% (23/29) countries, respectively. Availability of all POCTs varied between countries. In primary care, the country (MOR) varied from 1.61 (95%CI: 1.04-2.58) for lactate to 7.28 (95%CI: 3.04-24.35) for UD. In hospitals, the country MOR varied from 1.37 (95%CI:1.04-1.80) for lactate to 11.93 (95% CI:3.35-72.23) for UD. Most paediatricians in primary care (69%, 795/1154) and hospital (81%, 962/1188) would use a diagnostic test in the case scenario of an infant with undifferentiated fever. Multilevel regression modelling showed that the country of work was more important in predicting both the availability and use of POCTs than individual or workplace characteristics. Conclusion There is substantial variability in the adoption of POCTs for the management of acute infections in children across Europe. To inform future implementation of both existing and innovative tests, further research is needed to understand what drives the variation between countries, the needs of frontline clinicians, and the role of diagnostic tests in the management of acute childhood infections.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/36538525

UR - http://www.scopus.com/inward/record.url?scp=85144588983&partnerID=8YFLogxK

U2 - https://doi.org/10.1371/journal.pone.0275336

DO - https://doi.org/10.1371/journal.pone.0275336

M3 - Article

C2 - 36538525

SN - 1932-6203

VL - 17

JO - PLOS ONE

JF - PLOS ONE

IS - 12 December

M1 - e0275336

ER -

Availability and use of rapid diagnostic tests for the management of acute childhood infections in Europe: A cross-sectional survey of paediatricians

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