Written by Vivian Lei
Comprehensive respiratory viral panel testing in pediatric ED patients adds cost, increases length of stay, and does not decrease antimicrobial use.
Why does this matter?
Pediatric patients are commonly seen in the ED for fever and respiratory infections which are most often due to viral pathogens. While these illnesses typically resolve with supportive treatment alone, there is increasing use of diagnostic tests such as PCR-based comprehensive respiratory viral panel (CRVP) testing, although the clinical utility and cost implications are not well-defined.
Knowledge is not wisdom
This study was a single center, retrospective chart review of pediatric ED patients who were diagnosed with acute URI, fever, and/or bronchiolitis. A total of 5,766 visits were included, with 229 (4%) undergoing CRVP testing. Median age was 16 months. Of those tested, 163 (71.2%) had a positive result for at least 1 organism (most commonly rhinovirus/enterovirus, then RSV). Median total charge in the CRVP group was $643.39 vs $295.15 in those who did not receive CRVP testing, and median length of stay was 4 hours vs 2 hours, respectively. A total of 114 out of the 5,766 patients received antimicrobials, with more given to the group undergoing CRVP testing: 16 (7%) vs 98 (1.8%), regardless of CRVP result. This study supports the IDSA and “Choosing Wisely” recommendations against obtaining routine CRVP testing in otherwise healthy children with URI or fever.
Use and Cost Analysis of Comprehensive Respiratory Panel Testing in a Pediatric Emergency Department. Pediatr Emerg Care. 2023 Mar 1;39(3):154-158. doi: 10.1097/PEC.0000000000002695. Epub 2022 Apr 12.