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Respiratory virus testing and clinical outcomes among children hospitalized with pneumonia
Daniel J Shapiro1, Cary W Thurm2, Matthew Hall2
1Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
Respiratory virus testing for children with community-acquired pneumonia (CAP) varied widely across hospitals and did not impact clinical outcomes like length of stay or antibiotic use. These findings suggest viral diagnostic tests may not significantly influence patient management in many cases.
Area of Science:
- Pediatric infectious diseases
- Clinical diagnostics
- Health services research
Background:
- The clinical utility of respiratory virus diagnostic tests for children with community-acquired pneumonia (CAP) remains unclear despite increased availability.
- Understanding testing patterns and their impact is crucial for optimizing pediatric healthcare.
Purpose of the Study:
- To examine respiratory virus testing trends in children's hospitals before the COVID-19 pandemic.
- To determine if hospital-level viral testing rates correlate with clinical outcomes in pediatric CAP cases.
Main Methods:
- A retrospective cohort study analyzed data from 46,038 hospitalizations for non-severe CAP across 19 U.S. children's hospitals (2010-2019).
- Assessed trends in viral test utilization, including molecular and antigen methods.
- Correlated testing proportions with length of stay, antibiotic/antiviral use, and ancillary lab testing.
Main Results:
- The overall proportion of pediatric CAP hospitalizations with viral testing increased from 38.8% to 44.2% (p < .001).
- Molecular testing use rose, while antigen testing decreased; however, hospital testing rates varied significantly (10.0% to 83.5%).
- Higher rates of viral testing were not associated with shorter length of stay, reduced antibiotic or antiviral use, or lower rates of other lab tests.
Conclusions:
- Significant variation exists in viral diagnostic testing practices for pediatric CAP among children's hospitals.
- Current viral testing strategies do not appear to influence key clinical process or outcome measures.
- The impact of viral testing on clinical management for hospitalized children with CAP may be limited.
Background:
Despite the increased availability of diagnostic tests for respiratory viruses, their clinical utility for children with community-acquired pneumonia (CAP) remains uncertain.
Objective:
To identify patterns of respiratory virus testing across children's hospitals prior to the COVID-19 pandemic and to determine whether hospital-level rates of viral testing were associated with clinical outcomes.
Design, Setting, And Participants:
Multicenter retrospective cohort study of children hospitalized for CAP at 19 children's hospitals in the United States from 2010-2019.
Main Outcomes And Measures:
Using a novel method to identify the performance of viral testing, we assessed time trends in the use of viral tests, both overall and stratified by testing method. Adjusted proportions of encounters with viral testing were compared across hospitals and were correlated with length of stay, antibiotic and oseltamivir use, and performance of ancillary laboratory testing.
Results:
There were 46,038 hospitalizations for non-severe CAP among children without complex chronic conditions. The proportion with viral testing increased from 38.8% to 44.2% during the study period (p < .001). Molecular testing increased (27.2% to 40.0%, p < .001) and antigen testing decreased (33.2% to 7.8%, p < .001). Hospital-specific adjusted proportions of testing ranged from 10.0% to 83.5% and were not associated with length of stay, antibiotic use, or antiviral use. Hospitals that performed more viral testing did not have lower rates of ancillary laboratory testing.
Conclusions:
Viral testing practices varied widely across children's hospitals and were not associated with clinically important process or outcome measures. Viral testing may not influence clinical management for many children hospitalized with CAP.
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