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Use of a Rapid Diagnostic for Chlamydia trachomatis and Neisseria gonorrhoeae for Women in the Emergency Department Can Improve Clinical Management: Report of a Randomized Clinical Trial.
- Source :
-
Annals of emergency medicine [Ann Emerg Med] 2019 Jul; Vol. 74 (1), pp. 36-44. Date of Electronic Publication: 2018 Nov 02. - Publication Year :
- 2019
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Abstract
- Study Objective: In emergency departments (EDs), diagnosis and treatment of Chlamydia trachomatis and Neisseria gonorrhoeae are challenging. We conducted a randomized clinical trial to assess rapid C trachomatis and N gonorrhoeae testing on overtreatment and undertreatment of women evaluated for C trachomatis and N gonorrhoeae.<br />Methods: Women undergoing pelvic examinations and C trachomatis and N gonorrhoeae testing (n=254) were randomized to control or rapid test groups. The control group received standard-of-care C trachomatis and N gonorrhoeae nucleic acid amplification tests of endocervical specimens, with 2- to 3-day turnaround times. For the rapid test group, clinicians collected an extra endocervical swab for GeneXpert C trachomatis and N gonorrhoeae rapid testing, in addition to the standard-of-care nucleic acid amplification test swab. Rapid results were immediately provided, and all patients were treated according to providers' clinical judgment.<br />Results: In the rapid test group, 7.9% of patients had positive test results for C trachomatis; 3.9% had positive test results for N gonorrhoeae. In the control standard-of-care group, 10.2% of patients had positive nucleic acid amplification test results for C trachomatis; 5.5% had positive results for N gonorrhoeae. Undertreatment for both C trachomatis and N gonorrhoeae in the ED was 0% for the rapid test group and 43.8% for the control standard-of-care group. Clinicians overtreated 46.5% of uninfected standard-of-care control patients for C trachomatis compared with 23.1% of uninfected rapid test patients. For patients uninfected with N gonorrhoeae, clinicians overtreated 46.7% of standard-of-care control patients compared with 25.4% of rapid test patients. The length of stay did not differ significantly between groups.<br />Conclusion: Rapid C trachomatis and N gonorrhoeae testing in the ED led to a significant reduction in overtreatment for women without infections compared with the standard-of-care control group. Additionally, in the rapid test group there was significant improvement in appropriate treatment for patients with infections.<br /> (Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adolescent
Adult
Cervix Uteri metabolism
Cervix Uteri microbiology
Chlamydia Infections epidemiology
Chlamydia Infections microbiology
Chlamydia Infections therapy
Chlamydia trachomatis drug effects
Emergency Service, Hospital
Female
Gonorrhea epidemiology
Gonorrhea microbiology
Gonorrhea therapy
Humans
Length of Stay
Medical Overuse prevention & control
Medical Overuse statistics & numerical data
Middle Aged
Neisseria gonorrhoeae drug effects
Nucleic Acid Amplification Techniques methods
Prevalence
Prospective Studies
Sensitivity and Specificity
Specimen Handling
Standard of Care
Young Adult
Chlamydia Infections diagnosis
Chlamydia trachomatis isolation & purification
Gonorrhea diagnosis
Neisseria gonorrhoeae isolation & purification
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6760
- Volume :
- 74
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Annals of emergency medicine
- Publication Type :
- Academic Journal
- Accession number :
- 30392736
- Full Text :
- https://doi.org/10.1016/j.annemergmed.2018.09.012