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Role of a Respiratory Viral Panel in the Clinical Management of Pediatric Inpatients

Schulert, Grant S. MD, PhD*; Lu, Zengqi MS; Wingo, Tammy PhD, MBA; Tang, Yi-Wei MD, PhD§; Saville, Benjamin R. PhD; Hain, Paul D. MD

Pediatric Infectious Disease Journal: May 2013 - Volume 32 - Issue 5 - p 467–472
doi: 10.1097/INF.0b013e318284b146
Original Studies

Background: Respiratory viral panels (RVPs) able to detect multiple pathogens are increasingly used in the management of pediatric inpatients. Despite this, few studies have examined whether the results of these tests are associated with clinically significant changes in medical management.

Methods: In this retrospective cohort study, we identified pediatric inpatients between August 2009 and December 2010 for whom an RVP was ordered within 24 hours of admission to a large, tertiary-care children’s hospital. We used linear regression to determine whether RVP was associated with length of stay (LOS), duration of antibiotics and the number of diagnostic microbiology tests ordered, adjusting for potential confounders.

Results: We found that the association between results of the RVP and LOS was dependent on a patient’s admission service, specifically admission to the hematology/oncology service. We also found that patients with a positive RVP had a shorter duration of intravenous antibiotic administration (P = 0.03; 42% reduction in the geometric mean), but that this was influenced by the primary admission service. We also found that positive results of the RVP were associated with decreased LOS and shorter duration of antibiotics in patients with some common respiratory diagnoses.

Conclusions: This study lacked sufficient evidence to claim an association between a positive RVP and LOS in pediatric patients, adjusting for their underlying diagnosis. However, we found that a positive RVP was associated with a shorter duration of intravenous antibiotic administration in certain groups of patients and those with some common respiratory diagnoses. These findings help clarify the utility of rapid viral testing in the management of hospitalized pediatric patients.

From the Departments of *Pediatrics and Biostatistics; Monroe Carell Jr. Children’s Hospital; and §Department of Pathology, Vanderbilt University, Nashville, TN; and University of Texas Southwestern Medical Center and Children’s Medical Center, Dallas, TX.

Accepted for publication December 24, 2012.

Yi-Wei Tang, MD, PhD is currently at Memorial Sloan-Kettering Cancer Center, New York, NY, 10065.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Grant S. Schulert, MD, PhD, Doctors’ Office Tower, Room 8161, 2200 Children’s Way, Nashville, TN 37232. E-mail: grant.s.schulert@vanderbilt.edu.

© 2013 Lippincott Williams & Wilkins, Inc.