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The Clinical Utility of Respiratory Viral Testing in Hospitalized Children: A Meta-analysis

Kim C Noël1, Patricia S Fontela1,2, Nicholas Winters1

  • 1Departments of Epidemiology, Biostatistics and Occupational Health and.

Hospital Pediatrics
|June 7, 2019
PubMed

Insights

Respiratory virus (RV) testing in hospitalized children with severe acute respiratory infection (ARI) shows uncertain clinical utility. While not consistently reducing antibiotic use, prospective studies suggest RV testing may decrease antibiotic duration.

Area of Science:

  • Pediatric Infectious Diseases
  • Clinical Microbiology
  • Health Services Research

Background:

  • Respiratory virus (RV) detection tests are frequently used for hospitalized children with acute respiratory infection (ARI).
  • The clinical utility of these tests, particularly regarding antibiotic stewardship and patient outcomes, remains uncertain.

Purpose of the Study:

  • To systematically review and meta-analyze the impact of RV test results on antibiotic consumption, ancillary testing, hospital length of stay, and antiviral use in children hospitalized with severe ARI.
  • To assess the clinical utility of RV testing in pediatric severe ARI management.

Main Methods:

  • A systematic review and meta-analysis of studies published from 1985 to January 2018.
  • Inclusion of studies comparing RV testing versus no testing or positive versus negative RV test results in children (<18 years) hospitalized with severe ARI.
  • Data extraction and quality assessment performed independently by two reviewers.

Main Results:

  • Twenty-three studies were included, but high heterogeneity precluded an overall meta-analysis.
  • Subgroup analyses showed no difference in antibiotic proportion based on RV test results.
  • RV testing decreased antibiotic use in prospective cohort studies (OR=0.58) and may decrease antibiotic duration, but had no conclusive impact on chest radiograph use (OR=0.71).
  • Nineteen studies (83%) had a serious risk of bias.

Conclusions:

  • Low-quality studies and significant heterogeneity limit definitive conclusions.
  • Higher-quality prospective studies are required to clarify the impact of RV testing on antibiotic use in pediatric severe ARI.
  • Current evidence suggests RV testing may not consistently reduce antibiotic consumption but could shorten duration.
Abstract

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