PEDIATRIC INVESTIGATORS COLLABORATIVE NETWORK ON INFECTIONS IN CANADA(PICNIC) STUDY OF ADMISSION AND MANAGEMENT VARIATION IN PATIENTS HOSPITALIZED WITH RESPIRATORY SYNCYTIAL VIRAL LOWER RESPIRATORY-TRACT INFECTION

Objectives: To describe differences in patients hospitalized with resp iratory syncytial virus (RSV) lower respiratory tract infection (LRI) at nine Canadian tertiary care hospitals. In addition, this study desc ribes the variation in use of drug and other interventions. Methods: D ata on patients hospitalized with RSV LRI and their outcomes were pros pectively collected. Demographic data were obtained on enrollment by c enter study nurses. Data recorded daily included clinical assessment, oxygen saturation determination, and interventions (bronchodilators, s teroids, ribavirin, antibiotics, intensive care, and mechanical ventil ation) received during the day. Patients were divided into those with underlying diseases including congenital heart disease, chronic lung d isease, immunodeficiency, or multiple congenital anomalies and those w ho were previously healthy. Mean RSV-associated length of stay and the proportion of patients receiving each intervention in each group were determined by hospital. Results: A total of 1516 patients were enroll ed at nine hospitals during January I to June 30, 1993, and January 1 to April 30, 1994. Significant differences were observed among hospita ls in the proportion of patients with underlying disease, postnatal ag e less than 6 weeks, hypoxia, and pulmonary infiltrate on chest radiog raph. The mean length of stay varied among hospitals from 8.6 to 11.8 days and 4.6 to 6.7 days in compromised and previously healthy patient s, respectively. Except for receipt of bronchodilators, compromised pa tients were significantly more likely to receive interventions than pr eviously healthy patients. There was variation among hospitals in rece ipt of most interventions in compromised and previously healthy patien ts. This variation was statistically significant for previously health y patients but not statistically significant in those with underlying disease, because the numbers of patients in the latter group were much smaller. The magnitude of the variation for each intervention, howeve r, was not different between those with underlying disease compared wi th previously healthy patients. Conclusion: Differences exist among te rtiary pediatric hospitals in the nature of the patients admitted with RSV LRI. Variation occurred in the use of five interventions among th e hospitals, regardless of whether the patient had underlying illness or was previously healthy. Given their current widespread use, high co st, and potential side effects, randomized clinical trials are needed to determine the efficacy of different drug treatments used to treat i nfants hospitalized with RSV.