Influenza Antiviral Treatment and Length of Stay
Angela P Campbell1, Jerome I Tokars2, Sue Reynolds2
1Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia app4@cdc.gov.
Insights
Early antiviral treatment significantly shortened hospital stays for children hospitalized with influenza, particularly those with underlying conditions or in intensive care. Prompt treatment is key for better outcomes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Antiviral treatment is recommended for hospitalized influenza patients, but evidence in children is limited.
- This study addresses the gap in understanding antiviral efficacy for pediatric influenza hospitalizations.
Purpose of the Study:
- To evaluate the impact of antiviral treatment on hospital length of stay (LOS) in children hospitalized with influenza.
- To assess if early antiviral administration influences discharge probability and duration of hospitalization.
Main Methods:
- Two cohorts of children (<18 years) with laboratory-confirmed influenza were analyzed: one with underlying medical conditions (n=309) and an intensive care unit (ICU) cohort (n=299).
- Cox models and Kaplan-Meier survival analysis were used to determine the effect of antiviral receipt on LOS, with antiviral treatment as a time-dependent variable.
Main Results:
- Antiviral treatment within 2 days of illness onset significantly reduced LOS in both the medical conditions cohort (adjusted hazard ratio: 1.37) and the ICU cohort (adjusted hazard ratio: 1.46).
- This early treatment corresponded to a 37% and 46% increase in daily discharge probability, respectively.
- Treatment initiated 3 or more days after symptom onset showed no significant effect on LOS in either cohort.
Conclusions:
- Early antiviral treatment is associated with shorter hospitalizations in children with confirmed influenza, especially those with high-risk conditions or in the ICU.
- These findings support current guidelines recommending prompt empiric antiviral treatment for hospitalized influenza patients.
- Prompt administration of antivirals can improve clinical outcomes and reduce hospital resource utilization in pediatric influenza cases.
Background:
Antiviral treatment is recommended for hospitalized patients with suspected and confirmed influenza, but evidence is limited among children. We evaluated the effect of antiviral treatment on hospital length of stay (LOS) among children hospitalized with influenza.
Methods:
We included children <18 years hospitalized with laboratory-confirmed influenza in the US Influenza Hospitalization Surveillance Network. We collected data for 2 cohorts: 1 with underlying medical conditions not admitted to the ICU (n = 309, 2012-2013) and an ICU cohort (including children with and without underlying conditions; n = 299, 2010-2011 to 2012-2013). We used a Cox model with antiviral receipt as a time-dependent variable to estimate hazard of discharge and a Kaplan-Meier survival analysis to determine LOS.
Results:
Compared with those not receiving antiviral agents, LOS was shorter for those treated ≤2 days after illness onset in both the medical conditions (adjusted hazard ratio: 1.37, P = .02) and ICU (adjusted hazard ratio: 1.46, P = .007) cohorts, corresponding to 37% and 46% increases in daily discharge probability, respectively. Treatment ≥3 days after illness onset had no significant effect in either cohort. In the medical conditions cohort, median LOS was 3 days for those not treated versus 2 days for those treated ≤2 days after symptom onset (P = .005).
Conclusions:
Early antiviral treatment was associated with significantly shorter hospitalizations in children with laboratory-confirmed influenza and high-risk medical conditions or children treated in the ICU. These results support Centers for Disease Control and Prevention recommendations for prompt empiric antiviral treatment in hospitalized patients with suspected or confirmed influenza.
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