Clinical utility of polymerase chain reaction testing for enteroviral meningitis

Background, During summer enteroviral meningitis is a common cause of febri le illness in children, who are typically hospitalized for 2 to 3 days if b acterial infection is suspected. It has been hypothesized that a sensitive polymerase chain reaction (PCR) assay could quickly confirm the diagnosis a nd subsequently decrease hospitalization costs. However, to have maximum im pact results should be available within 24 h, This necessitates daily assay s on small numbers of samples. Methods. We examined the clinical utility of a PCR assay during two summers , comparing length of stay and charges. Only during the second summer were results reported to clinicians. Case controls were patients with negative P CR assay results but uncomplicated, presumed viral infections. We determine d the cost per case identified with and without pleocytosis as a screen for PCR testing. Results. During the first summer 25% (5/20) of patients with positive PCR a ssay results remained hospitalized for >2 days. During the second summer 10 .2% (6 of 59) of children with positive enteroviral PCR assay results but 3 7.9% (25 of 66) of case controls remained hospitalized for >2 days. The mea n length of hospitalization was significantly (P < 0.05) shorter for patien ts with positive PCR test results than for case controls. The material cost was similar to$238 per case identified. Conclusions. PCR testing has clinical utility for diagnosis of enteroviral meningitis. Although the demands for daily testing make the test expensive, it appears to be cost-effective with savings related to shorter hospital s tays.