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Principal Component Patterns of Pediatric Respiratory Viral Testing Across Health Care Settings
Danielle A Rankin1,2, Laura S Stewart1, James C Slaughter3
1Department of Pediatrics.
Insights
Clinician decisions for viral testing in children with acute respiratory infections (ARIs) depend on presentation patterns. Specific symptoms influence testing rates in emergency departments and hospitals.
Area of Science:
- Pediatric infectious diseases
- Clinical virology
- Health services research
Background:
- Viral testing is crucial for managing pediatric acute respiratory infections (ARIs).
- Factors influencing clinician decisions to order viral tests in children are not well understood.
- Understanding these factors is essential for optimizing testing strategies and patient care.
Purpose of the Study:
- To analyze patterns prompting viral testing in children with ARIs.
- To compare testing practices in emergency departments (EDs) versus hospitalized settings.
- To identify clinical presentation characteristics associated with viral test ordering.
Main Methods:
- Utilized active ARI surveillance data from November 2017 to February 2020.
- Included children aged 30 days to 17 years with fever or respiratory symptoms.
- Employed principal components analysis and logistic regression to analyze presentation patterns and testing odds.
Main Results:
- 4107 children were analyzed; 64% were seen in the ED and 36% hospitalized.
- Children with coviral presentation patterns in the ED had increased odds of receiving viral tests (OR 1.44).
- Rhinovirus-like symptoms were associated with decreased odds of viral testing in both ED (OR 0.29) and hospitalized children (OR 0.61).
Conclusions:
- Provider decisions for viral testing in pediatric ARIs are influenced by clinical presentation and healthcare setting.
- Specific symptom patterns, like coviral or rhinovirus-like presentations, significantly impact testing rates.
- Further research is needed to refine viral testing strategies for improved pediatric ARI management.
Background And Objectives:
Factors prompting clinicians to request viral testing in children are unclear. We assessed patterns prompting clinicians to perform viral testing in children discharged from an emergency department (ED) or hospitalized with an acute respiratory infection (ARI).
Methods:
Using active ARI surveillance data collected from November 2017 through February 2020, children aged between 30 days and 17 years with fever or respiratory symptoms who had a research respiratory specimen tested were included. Children's presentation patterns from their initial evaluation at each health care setting were analyzed using principal components (PCs) analysis. PC-specific models using logistic regression with robust sandwich estimators were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) between PCs and provider-ordered viral testing. PCs were assigned respiratory virus/viruses names a priori based on the patterns represented.
Results:
In total, 4107 children were enrolled and tested, with 2616 (64%) discharged from the ED and 1491 (36%) hospitalized. In the ED, children with a coviral presentation pattern had a 1.44-fold (95% CI, 1.24-1.68) increased odds of receiving a provider-ordered viral test than children showing clinical symptoms less representative of coviral-like infection. Whereas children in the ED and hospitalized with rhinovirus-like symptoms had 71% (OR, 0.29; 95% CI, 0.24-0.34) and 39% (OR, 0.61; 95% CI, 0.49-0.76) decreased odds, respectively, of receiving a provider-ordered viral test during their medical encounter.
Conclusions:
Viral tests are frequently ordered by clinicians, but presentation patterns vary by setting and influence the initiation of testing. Additional assessments of factors affecting provider decisions to use viral testing in pediatric ARI management are needed to maximize patient benefits of testing.
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