TITLE:

Rapid Antigen Detection Test for Respiratory Syncitial Virus

Diagnosis as a Diagnostic Tool

CLINICAL SCENARIO:
This is a case of a 3 years old male who came in due to dyspnea. History revealed that 3
days prior to consult, patient experienced low grade fever and nasal congestion. 1 day prior to
consult patient developed productive cough with whitish phlegm and loss of appetite. On the
day of consult, patient had onset of difficulty of breathing which prompted consult.
At the emergency room, patient is tachypneic at 55 cpm with note of subcostal retraction
and nasal flaring. Upon auscultation, wheezing was heard on all lung fields and chest x-ray
revealed minimal infiltrates bibasal. Folks were then advised for admission.

CLINICAL QUESTION:
How accurate is the QuickVue RSV Test kit as a screening tool for respiratory syncytial virus
in children with acute respiratory disease?

CITATION:
Directness
Clinical Question

Population 486 children under 5 years of age with acute respiratory infection

Exposure QuickVue RSV test kit

Outcome Positive detection of RSV
Method Retrospective study

Validity
The viral diagnosis of RSV can be accomplished by a number of
methods, including: cell culture, immunofluoresence assays
1. Was the reference (IFA), immune chromatographic assays, and polymerase chain
standard an reaction. The molecular methods have been used as the gold
acceptable one? standard, because of their specificity and ability to
simultaneously detect different viruses. In this particular study,
immunofluoresence assay was utilized
Yes, test samples were screened by indirect immunofluorescence
2. Was the reference assay using a commercial kit Light Diagnostics Respiratory
standard interpreted Panel Viral Screening and Identification separate from testing
independently from the samples via QuickVue RSV test dipstick immunoassay.
the test in the Furthermore, samples with discrepant results were subsequently
question? tested by real-time quantitative reverse transcription PCR and by
traditional PCR
Results
Number of samples
RADT Test Results IFA (gold standard)
Positive Negative Total
Positive 282 2 284
Negative 31 171 202
Total 313 173 486

Sensitivity (Sn) = 90.1%

Specificity (Sp) = 98.8%

Positive Predictive Value (PPV) = 99.3%

Negative Predictive Value (NPV) = 94.6%

Odds
Results Likelihood Ratio
Positive 77.9
Negative 0.1

Pre-test Odds = 1.5

Post-test Odds = 116.85

Assessing Applicability
Sex Yes, both sexes were included in the study.
Co-morbidities No, co-morbidities were not taken into consideration in this study.
Race Yes, race was not included in the exclusion criteria.
Age Yes, children less than 5 years old were included in the study.
Yes, The Respiratory syncytial virus (RSV) has been estimated by the
World Health Organization to infect 64 million people, and causes
Pathology 160,000 deaths per year. It is one of the major infectious agents of
respiratory tract infections. Clinical conditions caused by RSV ranges
for, the common cold to bronchiolitis, and pnuemonia.
 Individualizing the Results
60%

The value was derived from Nelson’s Textbook of Pediatrics

Pre-test Probability
20th Edition. According to the book, 40 – 80 % of viral
pneumonia is associated with RSV infection. We took the
median value for our pre – test probability.
Post-test Probability 99.15%
10%
Diagnostic Threshold
The value was estimated based on the sensitivity of the test,
since it was 90 %, we approximated the threshold to be 10 %.
90%
Therapeutic
Threshold
The value was still derived from the specificity of RADT.

Author’s Conclusion
The QuickVue RSV Test Kit displayed high predictive values and likelihood ratios, and
proved to be effective in the early screening and detection of RSV. It can be utilized as a
faster alternative diagnostic tool among pediatric patients as compared to the gold standard
immunofluorescence assay.

Reviewer’s Conclusion
Due to the high computed values, the QuickVue RSV Test Kit can be an effective tool in
the screening and detection of RSV among suspected pediatric patients. It can also be helpful
in decreasing the number of unnecessary antibiotic use, duration of hospital stay, and overall
medical expenses.

Clinical Bottom-line
Since RSV is known as a major causative agent of respiratory tract infections in children
worldwide, the test kit can be a valuable tool in its detection. However, the application of the
study can be done in our locality only if the test kit is readily available since the
immunofluorescence assay is also not available locally.

NAME: DATE: June 6, 2017

Asturias, Frank David
Dela Llana, Kevin Andre
Gregore, Alfred
Portigo, Angeli Nicole
Luntao, Theodor Diño
Mon, Johan Rey
Tantia, Angelie Marie