EFFECT OF RAPID VIRAL DIAGNOSIS ON THE MANAGEMENT OF CHILDREN HOSPITALIZED WITH LOWER RESPIRATORY-TRACT INFECTION

Background. Although rapid viral tests are commonly used in children w ith lower respiratory tract infection, their effect on patient managem ent has not been studied. Objectives. To examine how physicians utiliz e an enzyme immunoassay for respiratory syncytial virus (RSV EIA) and a centrifugation-enhanced cellular immunofluorescence assay fear multi ple viral pathogens [viral respiratory panel (VRP)] in children hospit alized with respiratory illness; to determine the effect of testing on length of stay, antibiotic use and costs; and to determine physician attitudes toward RSV testing. Design and setting. Prospective study an d survey at a large children's hospital. Patients. Previously healthy children < 24 months of age consecutively admitted Between January 1 a nd February 11, 1995, with symptoms of lower respiratory tract infecti on. Results. Of 200 patients 160 were tested by RSV EIA; 92 were posit ive and 68 were negative, Tested children were younger, more tachypnoe ic and more likely to require oxygen than those not tested. Overall th e length of stay was similar in RSV-positive and -negative patients. A lthough equal proportions of each group were given antibiotic therapy, RSV-positive children received antibiotic therapy for fewer days than RSV-negative children (median 2 vs. 3 days; P = 0.0387), However, a c rude cost analysis did not support a strategy of testing all bronchiol itis patients for RSV. Sixty-five of the 68 RSV-negative children were tested for RSV and otherpathogens by VRP. In 55 cases the results wer e not available until after patient discharge and could not have influ enced their management, One hundred three physicians caring for childr en in the study were surveyed, Of 75 respondents almost all thought th at RSV EIA results influenced their management of patients and were im portant to parents. Conclusions. Most children hospitalized with sympt oms of lower respiratory tract infection were tested for viral pathoge ns. The VRP provided little clinically useful information. In contrast RSV EIA results mag have been used by clinicians to make antibiotic d ecisions. Physicians felt that rapid testing for RSV was important.