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Trends in Respiratory Viral Testing in Pediatric Emergency Departments Following the COVID-19 Pandemic
Sriram Ramgopal1, Oluwakemi Badaki-Makun2, Mohamed Eltorki3
1Division of Emergency Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Insights
COVID-19 pandemic increased respiratory viral testing and costs in pediatric emergency departments (EDs). Testing remained high even as disease incidence declined, indicating a need for better testing guidelines.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Disease Epidemiology
- Health Services Research
Background:
- The COVID-19 pandemic significantly impacted healthcare utilization, particularly in emergency departments (EDs).
- Respiratory viral testing became a critical diagnostic tool during the pandemic.
- Understanding trends in testing and costs is crucial for resource allocation and clinical practice guidelines.
Purpose of the Study:
- To evaluate changes in the utilization and associated costs of respiratory viral testing in pediatric emergency departments (EDs) during the COVID-19 pandemic.
- To analyze trends in testing frequency and costs across different pandemic phases.
- To identify potential areas for optimizing diagnostic strategies in pediatric EDs.
Main Methods:
- A cross-sectional study analyzed data from 34 pediatric EDs from October 2016 to March 2024.
- Interrupted time series analysis was used to assess trends during prepandemic, early pandemic, and late pandemic periods.
- Included were over 15 million encounters of children aged 90 days to 18 years.
Main Results:
- Respiratory viral testing increased from 6.3% prepandemic to 24.3% in the early pandemic, remaining elevated at 19.1% in the late pandemic.
- Testing costs surged from approximately $5,000/month to $33,000/month during the early pandemic.
- Despite decreasing disease incidence, testing rates remained significantly higher than prepandemic levels.
Conclusions:
- Respiratory viral testing and its costs substantially increased in pediatric EDs during the COVID-19 pandemic.
- Sustained high testing rates, irrespective of disease incidence, suggest a need to refine testing indications.
- Further efforts are required to reduce low-value testing and optimize diagnostic pathways in pediatric emergency care.
Study Objective:
To evaluate for increases in the use and costs of respiratory viral testing in pediatric emergency departments (EDs) because of the COVID-19 pandemic.
Methods:
We performed a cross-sectional study using the pediatric health information system. Eligible subjects were children (90 days to 18 years) who were discharged from a pediatric ED and included in the pediatric health information system from October 2016 through March 2024. To evaluate for changes in the frequency and costs of respiratory viral testing, we performed an interrupted time series analysis across 3 study periods: prepandemic (October 1, 2016 to March 14, 2020), early pandemic (March 15, 2020 to December 31, 2023), and late pandemic (January 1, 2023 to March 31, 2024).
Results:
We included 15,261,939 encounters from 34 pediatric EDs over the 90-month study period. At least 1 viral respiratory test was performed for 460,826 of 7,311,177 prepandemic encounters (6.3%), 1,240,807 of 5,100,796 early pandemic encounters (24.3%), and 545,696 of 2,849,966 late pandemic encounters (19.1%). There was a positive prepandemic slope in viral testing (0.17% encounters/month; 95% CI 0.17 to 0.18). The early pandemic was associated with a shift change of 4.98% (95% CI 4.90 to 5.07) and a positive slope (0.54% encounters/month; 95% CI 0.54 to 0.55). The late pandemic period was associated with a negative shift (-17.80%; 95% CI -17.90 to -17.70) and a positive slope (0.42% encounters/month; 95% CI 0.41 to 0.42). The slope in testing costs increased from $5,000/month (95% CI $4,200 to $5,700) to $33,000/month (95% CI $32,000 to $34,000) during the early pandemic.
Conclusion:
Respiratory testing and associated costs increased during the COVID-19 pandemic and were sustained despite decreasing incidence of disease. These findings highlight a need for further efforts to clarify indications for viral testing in the ED and efforts to reduce low-value testing.
