Availability and use of rapid diagnostic tests for the management of acute childhood infections in Europe: A cross-sectional survey of paediatricians
Authors: Dewez Juan Emmanuel , Pembrey Lucy , Nijman Ruud G. , del Torso Stefano , Grossman Zachi , Hadjipanayis Adamos , Van Esso Diego , Lim Emma , Emonts Marieke , Burns James , Gras-LeGuen Christèle , Kohlfuerst Daniela , Dornbusch Hans Jürgen , Brengel-Pesce Karen , Mallet Francois , von Both Ulrich , Tsolia Maria , Eleftheriou Irini , Zavadska Dace , de Groot Ronald , van der Flier Michiel , Moll Henriëtte , Hagedoorn Nienke , Borensztajn Dorine , Oostenbrink Rianne , Kuijpers Taco , Pokorn Marko , Vincek Katarina , Martinón-Torres Federico , Rivero Irene , Agyeman Philipp , Carrol Enitan D. , Paulus Stéphane , Cunnington Aubrey , Herberg Jethro , Levin Michael , Mujkić Aida , Geitmann Karin , Da Dalt Liviana , Valiulis Arūnas , Lapatto Risto , Syridou Garyfallia , Altorjai Péter , Torpiano Paul , Størdal Ketil , Illy Károly , Mazur Artur , Spreitzer Mateja Vintar , Rios Joana , Wyder Corinne , Romankevych Ivanna , Basmaci Romain , Ibanez-Mico Salvador , Yeung Shunmay 
Published: December 2022

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.