***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Managing children with influenza-like illness is associated with costly and painful interventions because , in order to distinguish viral from bacterial infections , diagnostic tests ( including routine blood examinations and chest radiographs ) are frequently performed,1,2 and the empirical use of antimicrobial agents is common.3 Various rapid diagnostic techniques for the detection of influenza viruses have been developed , but few data are available on their impact on child care.2,4,5 The aim of this study was to assess the effect of a rapid diagnosis of influenza infection on the management of children with influenza-like illness in an emergency department . All patients seen for influenza-like illness from 6 January to 27 February 2002 , at the paediatric emergency department of the University of Milan , Italy , were enrolled and blindly r and omly assigned in a 1:1 ratio to undergo a rapid test for the detection of influenza viruses or no rapid test . Influenza-like illness was defined as an axillary temperature of ⩾37.8 ° C and at least one symptom of acute upper or lower respiratory tract disease.6 The patients who underwent the test had their throats swabbed after vigorously rubbing both tonsillar surfaces and the posterior pharynx ; the swab was then immediately su bmi tted to the Quickvue influenza test ( Quidel , Milan , Italy ) for the rapid detection of influenza A and B viruses . The test , which has an overall sensitivity of 74–95 % and an overall specificity of 76–98%,5,7,8 was performed by a postgraduate student in accordance with the manufacturer ’s recommendations . The results were available after 10 Recent empirical evidence supports the importance of adequate r and omization in controlled trials . Trials with inadequate allocation concealment have been associated with larger treatment effects compared with trials in which authors reported adequate allocation concealment . While that provides empirical evidence of bias being interjected into trials , trial investigators rarely document the sensitive details of subverting the intended purpose of r and omization . This article relates anonymous accounts run the gamut from simple to intricate operations , from transillumination of envelopes to search ing for code in the office files of the principal investigator . They indicate that deciphering is something more frequent than a rate occurrence . These accounts prompt some method ological recommendations to help prevent deciphering . R and omized controlled trials appear to annoy human nature -- if properly conducted , indeed they should OBJECTIVE To determine the impact of the rapid diagnosis of influenza on physician decision-making and patient management , including laboratory tests and radiographs ordered , patient charges associated with these tests , antibiotics/antivirals prescribed , and length of time to patient discharge from the emergency department . METHODS Patients aged 2 months to 21 years presenting to an urban children 's teaching hospital emergency department were screened for fever and cough , coryza , myalgias , headache , and /or malaise . After obtaining informed consent , patients were r and omized to 1 of 2 groups : 1 ) physician receives ( physician aware of ) the rapid influenza test result ; or 2 ) physician does not receive ( physician unaware of ) the result . For patients in the physician aware group , nasopharyngeal swabs were obtained , immediately tested with the FluOIA test for influenza A and B , and the result was placed on the chart before patient evaluation by the attending physician . For the physician unaware group , nasopharyngeal swabs were obtained , stored according to manufacturer 's directions , and tested within 24 hours . Results for the physician unaware group were not disclosed to the treating physicians at any time . The 2 result ant influenza-positive groups ( aware and unaware ) were compared for laboratory and radiograph studies and their associated patient charges , antibiotic/antiviral prescriptions , and length of stay in the emergency department . RESULTS A total of 418 patients were enrolled , and 391 completed the study . Of these , 202 tested positive for influenza . Comparison of the 96 influenza-positive patients whose physician was aware of the result with the 106 influenza-positive patients whose physician was unaware of the result revealed significant reductions among the former group in : 1 ) numbers of complete blood counts , blood cultures , urinalyses , urine cultures , and chest radiographs performed ; 2 ) charges associated with these tests ; 3 ) antibiotics prescribed ; and 4 ) length of stay in the emergency department . The number of influenza-positive patients who received prescriptions for antiviral drugs  was significantly higher among those whose physician was aware of the result . CONCLUSIONS Physician awareness of a rapid diagnosis of influenza in the pediatric emergency department significantly reduced the number of laboratory tests and radiographs ordered and their associated charges , decreased antibiotic use , increased antiviral use , and decreased length of time to discharge OBJECTIVES Acute respiratory tract infections represent a significant burden on pediatric emergency departments ( ED ) and families . We hypothesized that early and rapid diagnosis of a viral infection alleviates the need for ancillary testing and antibiotic treatment . STUDY DESIGN We conducted a r and omized , controlled trial of children 3 to 36 months of age with febrile acute respiratory tract infections at a pediatric ED . Two hundred four subjects were r and omly assigned to receive rapid respiratory viral testing on admission or a routine ED admission protocol . Outcome measures were : mean length of visits , rate of ancillary tests , and antibiotic prescription in the ED . A follow-up call was made to all study subjects to inquire about further healthcare visits , ancillary testing , and antibiotic prescription after ED discharge . RESULTS We did not find a statistically significant difference in ED length of visits , rate of ancillary testing , or antibiotic prescription rate in the ED between the study groups . There was , however , a significant reduction in antibiotic prescription after ED discharge ( in the group who had rapid viral testing RR = 0.36 ; 95 % CI = 0.14 , 0.95 ) . CONCLUSIONS Rapid multi-viral testing in the ED did not significantly affect ED patient treatment but may reduce antibiotic prescription in the community after discharge from the ED , suggesting a novel strategy to alter community physician antibiotic prescription patterns BACKGROUND Evidence shows that the rapid detection of influenza using an enzyme-linked immunosorbent assay decreases antibiotic use in the treatment of pediatric patients . To our knowledge , the effect on other diagnostic testing in an emergency department ( ED ) has not been examined . OBJECTIVE To determine the effect of rapid diagnosis of influenza virus type A on the clinical management of febrile infants and toddlers in a pediatric ED at an urban children 's hospital . MATERIAL S AND METHODS A retrospective review of ED records from an electronic data base was performed . All children 2 to 24 months of age , with a temperature higher than 39 degrees C who had a positive influenza virus type A test result using an enzyme-linked immunosorbent assay from November 1 , 1998 , through April 30 , 2000 ( n = 72 ) , were included in this study . Two groups were compared-those who had positive test results reported before discharge from the ED ( early diagnosis ) and those who had positive test results after discharge ( late diagnosis ) . RESULTS Forty-seven patients ( 65 % ) were in the early diagnosis group and 25 ( 35 % ) in the late diagnosis group . The groups were similar for age , temperature , and triage category . Fewer patients in the early diagnosis group received  ceftriaxone sodium  compared with those in the late diagnosis group ( 2 % vs 24 % , P = .006 ) ; there were fewer urinalyses ( 2 % vs 24 % , P = .006 ) and complete blood cell counts performed ( 17 % vs 44 % , P = .02 ) . CONCLUSIONS Rapid confirmation of influenza virus type A infection seems to decrease ancillary tests and antibiotic use in febrile infants and toddlers in the ED . A prospect i ve study with a larger group is needed to confirm these findings BACKGROUND The evaluation of young febrile infants is controversial , in part because it is unclear whether clinical evidence of a viral infection significantly reduces the risk of serious bacterial infections ( SBIs ) . Specifically , it remains unclear whether the risk of SBI is altered in a meaningful way in the presence of respiratory syncytial virus ( RSV ) infections . OBJECTIVE The objective of this study was to determine the risk of SBI in young febrile infants who are infected with RSV compared with those without RSV infections . METHODS We conducted a 3-year multicenter , prospect i ve , cross-sectional study . All febrile ( > or = 38 degrees C ) infants who were < or = 60 days of age and presented to any of 8 pediatric emergency departments from October through March 1998 - 2001 were eligible . General clinical appearance was evaluated using the Yale Observational Scale . We determined RSV status by antigen testing of nasopharyngeal secretions . We defined bronchiolitis as either wheezing alone or chest retractions in association with an upper respiratory infection . We evaluated infants with blood , urine , cerebrospinal fluid , and stool cultures .  Urinary tract infection ( UTI ) was defined by single pathogen growth of > or = 5 x 10(4 ) cfu/mL , or > or = 10(4 ) cfu/mL in association with a positive urinalysis in a catheterized specimen , or > or = 10(3 ) cfu/mL in a suprapubic aspirate . Bacteremia , bacterial meningitis , and bacterial enteritis were defined by growth of a known bacterial pathogen . SBI was defined as any of the above-mentioned 4 bacterial infections . RESULTS We enrolled 1248 patients , including 269 ( 22 % ) with RSV infections . The overall SBI status could be determined in 1169 ( 94 % ) of the 1248 patients , and the rate of SBIs was 11.4 % ( 133 of 1169 ; 95 % confidence interval [ CI ] : 9.6%-13.3 % ) . The rate of SBIs in the RSV-positive infants was 7.0 % ( 17 of 244 ; 95 % CI : 4.1%-10.9 % ) compared with 12.5 % ( 116 of 925 ; 95 % CI : 10.5%-14.8 % ) in the RSV-negative infants ( risk difference : 5.5 % ; 95 % CI : 1.7%-9.4 % ) . The rate of UTI in the RSV-positive infants was 5.4 % ( 14 of 261 ; 95 % CI : 3.0%-8.8 % ) compared with 10.1 % ( 98 of 966 ; 95 % CI : 8.3%-12.2 % ) in the RSV-negative infants ( risk difference : 4.7 % ; 95 % CI : 1.4%-8.1 % ) . The RSV-positive infants had a lower rate of bacteremia than the RSV-negative infants ( 1.1 % vs 2.3 % ; risk difference : 1.2 % ; 95 % CI : -0.4 % to 2.7 % ) . No RSV-positive infant had bacterial meningitis ( 0 of 251 ; 95 % CI : 0%-1.2 % ) ; however , the differences between the 2 groups with regard to bacteremia and bacterial meningitis did not achieve statistical significance . CONCLUSIONS Febrile infants who are < or = 60 days of age and have RSV infections are at significantly lower risk of SBI than febrile infants without RSV infection . Nevertheless , the rate of SBIs , particularly as a result of UTI , remains appreciable in febrile RSV-positive infants OBJECTIVES To determine the effect of point-of-care testing ( POCT ) for influenza on the physician management of febrile children who are at risk for serious bacterial illness ( SBI ) on the basis of age and temperature and who are presenting to a pediatric emergency department ( ED ) during an influenza outbreak . METHODS Patients 2 - 3 months of age with temperature of > or = 38 degrees C and patients 3 - 24 months of age with temperature of > or = 39 degrees C who were presenting to a pediatric ED during an influenza outbreak were enrolled into a prospect i ve , quasi-r and omized , controlled trial . Influenza testing was performed on enrolled patients by either the POCT or the st and ard-testing ( ST ) methods . The two groups were compared in terms of laboratory testing , chest radiography , antibiotic use , visit-associated costs , pediatric ED lengths of stay , inpatient admission , and return visits to the pediatric ED . Similar analyses also were performed on the result ing subgroups of patients on the basis of method of testing ( POCT or ST ) and test result ( positive or negative ) . RESULTS Of 767 eligible patients , 700 ( 91 % ) completed the study . No significant differences were demonstrated between the POCT and ST groups with respect to laboratory tests ordered , chest radiographs obtained , antibiotic administration , inpatient admission , return visits to the pediatric ED , lengths of stay , or visit-associated costs . In the subgroup analysis , the adjusted odds ratios ( ORs ) for blood culture in influenza test-positive to -negative patients were 0.59 and 0.71 in the POCT and ST groups , respectively ( p = 0.088 ) . The adjusted ORs for urine culture in influenza test-positive to -negative patients were 0.46 and 0 
    Output:
    
None of the studies definitively blinded participants .Rapid viral testing result ed in a trend toward decreased antibiotic use in the ED , but this was not statistically significant .
There is insufficient evidence to support routine rapid viral testing to reduce antibiotic use in pediatric EDs .
However , rapid viral testing does reduce the rate of chest X-rays in the ED .