Respiratory testing infants with fever presenting to emergency care: A pilot study (REFINE)

A new Welsh-led study aims to investigate whether rapid Point Of Care (POC) testing for 3 common respiratory viruses in infants can help reduce the need for invasive procedures, hospital admissions and antibiotic use.

The REFINE study is a pilot randomised controlled trial (RCT), funded by Health and Care Research Wales, aiming to recruit 60 infants presenting with fever to Emergency Departments (EDs) across two Welsh Hospitals.

Fever is the second most common reason babies are brought to EDs for care. Infants under three months of age are particularly vulnerable and face a higher risk of undergoing invasive medical procedures than older children. Rapid POC testing in REFINE will test for 3 common viruses; RSV (Respiratory Syncytial Virus), COVID (SARS-CoV-2), and Flu (Influenza), and utilises a single swab from either the nose or throat and provides quick results to Drs in the ED.

Infants enrolled in the study will be randomly assigned to receive either standard care or standard care with the addition of the POC test. The REFINE team will assess the feasibility of delivering this study on a larger scale trial across multiple UK hospital Trusts.

The REFINE study is being run from the Centre for Trials Research (CTR) at Cardiff University in collaboration with Cardiff and Vale University Health Board (CAVUHB). It is led by Dr Jordan Evans and Dr Joanne Euden.  Dr Jordan Evans holds a research time award from Health and Care Research Wales, and is a consultant in paediatric emergency medicine at CAVUHB.

Dr Joanne Euden is a research fellow in the division of Infection, Inflammation and Immunity at the CTR and theme led for Infectious diseases within the division.

“ When a young baby is brought to the Emergency Department with a fever, we need to quickly assess the risk of serious infections such as meningitis and sepsis.  Through the REFINE study, we’re taking the first step to explore whether rapid viral testing can help safely identify babies at low risk of these serious infections, meaning fewer painful procedures and quicker discharge home with their families.

REFINE is an exciting example of how Welsh-led research can directly translate to clinical practice. By bringing together clinicians, researchers, and patient representatives from across Wales, we’re laying the groundwork for studies that could influence infant care across the UK and beyond.”

- Dr Jordan Evans (Consultant in paediatric emergency medicine, Cardiff and Vale University Health Board)

“I’m delighted to be co-lead on this study, working with CAVUHB to deliver this important research. We are hopeful that this pilot study will lead to a much larger, multi-site RCT across the UK, to further explore the clinical outcome of infants when a POC test has been implemented into their care.”

- Dr Joanne Euden (Centre for Trials Research, Cardiff University)

Collaborating partners on the study include academics from the Swansea Centre for Health Economics, CEDAR (Centre for Healthcare Evaluation, Device Assessment, and Research - a collaboration between CAVUHB and Cardiff University), and clinicians from Cwm Taf Health Board. The study team are also working with Patient and Public (PPI) members to help guide the study design and documentation. The study is funded by Health and Care Research Wales and runs for 21 months, with results expected in 2027. The Centre for Trials Research at Cardiff University is funded by Welsh Government through Health and Care Research Wales.

For enquiries about the study, please email REFINE@cardiff.ac.uk