There is substantial variability in the adoption of point-of-care tests (POCTs) for the management of acute infections in children across Europe, according to the results of a survey published in PLoS ONE.

POCTs are designed to be carried out near the patient and to provide accurate results quickly. The type of POCT that most people will now be most familiar with, is the lateral flow test commonly used for detecting for SARS-CoV2 (COVID-19). The use of POCTs is encouraged as a strategy to reduce the excess use of antibiotics and therefore the subsequent risk of antimicrobial resistance.

This online survey, which was conducted prior to the COVID pandemic (from September to November 2019), aimed to document the availability and use of POCTs in the diagnosis and management of children with fever. The survey questions included asking paediatricians what, if any, POCTs they would use in a common but sometimes tricky clinical scenario of a 4-month-old infant with a fever.

A total of 2,342 paediatricians working in hospitals and primary care facilities responded to the survey across 29 countries in Europe. Paediatricians were asked about 9 different POCTs including tests for Group A Streptococcus (GAS), influenza or respiratory syncytial virus (RSV), urine dipsticks and blood tests that measure reactions to infections, for example by counting white blood cells.

The study found that the availability and use of POCTs varied considerably across countries.

Professor Shunmay Yeung, paediatrician and infectious disease specialist at the London School of Hygiene & Tropical Medicine (LSHTM) and MARCH member, who led the research, said: “Prior to the study I was very aware that our use of point-of-care tests in England was much lower compared to some of our colleagues from other countries in Europe. However, I was really surprised at how much variation there was across Europe, especially in diagnostic tests like the rapid Group A strep test which is very widely used in some countries but not at all in others.”

In the primary care setting, urine dipsticks and GAS POCTs were the most available test and were available to over 80% of paediatricians in 68% and 63% of countries respectively. In hospitals urine dipsticks and blood gas POCTs were the most common and available in more than 80% of hospitals in 79% of countries. Operating as a private healthcare facility was found to be associated with an increased odds in the availability of some POCTs.

The study team, which included colleagues from across Europe, recognise that they cannot explain the variation in availability and use of POCTs across these countries as it is likely due to a complex interplay of factors in each country. These factors could include: differences in patient care pathways; the availability of resources; the existence of alternative diagnostic tools; or the capacity and readiness to innovate.

The study highlights the need for further research to understand what causes variation between countries and the needs of paediatricians. The findings hope to inform the implementation of future and existing tests across Europe.

Read the paper.