• Ji Young Lee, Seung Hwan Baek, Jong Gyun Ahn, Seo Hee Yoon, Moon Kyu Kim, Soo Yeon Kim, Kyung Won Kim, Myung Hyun Sohn, and Ji-Man Kang.
• Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.
• J. Korean Med. Sci. 2022 Jan 3; 37 (1): e3.

BackgroundWe aimed to examine the delay in antiviral initiation in rapid antigen test (RAT) false-negative children with influenza virus infection and to explore the clinical outcomes. We additionally conducted a medical cost-benefit analysis.MethodsThis single-center, retrospective study included children (aged < 10 years) with influenza-like illness (ILI), hospitalized after presenting to the emergency department during three influenza seasons (2016-2019). RAT-false-negativity was defined as RAT-negative and polymerase chain reaction-positive cases. The turnaround time to antiviral treatment (TAT) was from the time when RAT was prescribed to the time when the antiviral was administered. The medical cost analysis by scenarios was also performed.ResultsA total of 1,430 patients were included, 7.5% were RAT-positive (n = 107) and 2.4% were RAT-false-negative (n = 20). The median TAT of RAT-false-negative patients was 52.8 hours, significantly longer than that of 4 hours in RAT-positive patients (19.2-100.1, P < 0.001). In the multivariable analysis, TAT of ≥ 24 hours was associated with a risk of severe influenza infection and the need for mechanical ventilation (odds ratio [OR], 6.8, P = 0.009 and OR, 16.2, P = 0.033, respectively). The medical cost varied from $11.7-187.3/ILI patient.ConclusionAntiviral initiation was delayed in RAT-false-negative patients. Our findings support the guideline that children with influenza, suspected of having severe or progressive infection, should be treated immediately.© 2022 The Korean Academy of Medical Sciences.

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