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Predictive value of the respiratory syncytial virus risk-scoring tool in the term infant in Canada
Bosco Paes1, Mara Cole, Andrew Latchman
1Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada. paes@mcmaster.ca
Insights
A risk-scoring tool did not effectively predict hospitalization for term infants with respiratory syncytial virus (RSV). Further research is needed to identify accurate risk factors for RSV hospitalization in this population.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Palivizumab prophylaxis is standard for high-risk infants against respiratory syncytial virus (RSV).
- Guidelines for prophylaxis vary by country.
- Cost-effectiveness of prophylaxis is a concern.
Purpose of the Study:
- To evaluate a validated risk-scoring tool (RST) for predicting hospitalization in term infants with RSV.
- To determine if the RST can target prophylaxis cost-effectively.
Main Methods:
- Retrospective descriptive study of 72 term, RSV-positive infants.
- Chart review of 68 infants to assess risk categories using the RST.
- Statistical analysis including chi-square tests and ANOVA.
Main Results:
- Most infants (n=44) scored in the low-risk category.
- 61% of low-risk infants were hospitalized.
- The RST did not significantly differentiate between hospitalized and discharged infants (p=0.17).
Conclusions:
- The studied risk-scoring tool was not effective in predicting hospitalization for RSV-positive term infants.
- Universal prophylaxis for this cohort is financially prohibitive.
- Larger studies are needed to identify accurate risk factors for RSV hospitalization.
Background:
Palivizumab prophylaxis against respiratory syncytial virus (RSV) infection has been widely adopted for high-risk infants during the RSV season, based on country-specific guidelines.
Objective:
To determine if a validated, risk-scoring tool (RST), can be applied to term, RSV-positive infants seen in the emergency room (ER) to predict need for hospitalization, in order to target prophylaxis cost effectively at a selected group of children.
Design:
Retrospective, descriptive study.
Setting:
McMaster Children's Hospital in Hamilton, Ontario, Canada.
Participants:
A total of 72, consecutive, term, RSV-positive cases were identified retrospectively, from November through April during the 2006-2007 RSV season.
Methods:
A questionnaire/chart review was conducted on 68 of 72 cases, to determine risk categories based on the RST. Four, trained abstractors, extracted pertinent data from the medical records of RSV-positive patients. Means, standard deviations (SD), and percents were used to describe the study variables for hospitalized and ER patients discharged home. Chi-square tests were used to compare infants' risk factors to hospitalization. ANOVA was used for comparisons within and between risk groups and RST scores. A p-value of <0.05 was considered statistically significant.
Results:
The majority of infants scored in the low-risk category (n = 44), versus moderate (n = 16) or high risk (n = 8). Within the low-risk category, 27 (61%) of children were admitted to hospital compared to 17 (39%) who were treated in the ER and discharged home. The mean RST scores for those admitted to the pediatric intensive care unit/ward, the ward only, or those discharged home from the ER were 48.3 (n = 10), 41.0 (n = 36), and 36.5 (n = 22), respectively (p = 0.17). The mean number of risk factors for those discharged home versus hospitalized patients was 2.5 (1.3) and 2.97 (1.13), respectively (p = 0.15). Only two of eight cases in the high-risk group required intensive care.
Conclusions:
Overall, the risk-scoring tool did not discriminate between low versus moderate- to high-risk RSV-positive term infants who require hospitalization which has cost implications, since universal prophylaxis of this cohort would be financially prohibitive. A larger study is necessary to establish risk factors that more accurately determine RSV hospitalization among term infants.
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