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Trends in Respiratory Pathogen Testing at US Children's Hospitals
Matthew J Molloy1,2, Matthew Hall3, Jessica L Markham4,5
1Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Respiratory pathogen testing rates in children significantly increased, especially during the COVID-19 pandemic, leading to higher costs. This highlights a need for deimplementation strategies to manage testing volume and expenses.
Area of Science:
- Pediatric infectious diseases
- Health services research
- Epidemiology
Background:
- Respiratory pathogen testing is a common focus for deimplementation.
- The COVID-19 pandemic introduced new complexities to respiratory testing practices.
- Understanding recent trends in pediatric respiratory testing rates and costs is crucial.
Purpose of the Study:
- To measure trends in respiratory testing for acute respiratory infections in children (<18 years) from 2016-2023.
- To assess the impact of COVID-19 on these testing trends.
- To describe associated cost trends for respiratory pathogen testing.
Main Methods:
- Retrospective serial cross-sectional study using the Pediatric Health Information System database (2016-2023).
- Included emergency department (ED) encounters and hospitalizations for acute infectious respiratory illness in US children's hospitals.
- Interrupted time series models analyzed testing patterns and costs, adjusting for inflation.
Main Results:
- Respiratory testing increased from 13.6% in 2016 to a peak of 62.2% in 2022.
- The COVID-19 pandemic onset saw significant increases in testing rates (ED-only: 33.78%, hospitalizations: 30.97%).
- Inflation-adjusted costs per encounter rose from $34.2 in 2017 to $128.2 in 2022.
Conclusions:
- Pediatric respiratory testing rates have substantially increased, with sustained elevation post-pandemic.
- Significant increases in testing rates and associated costs necessitate future deimplementation efforts.
- Findings support the need to re-evaluate and optimize respiratory pathogen testing strategies in pediatric care.
Importance:
Respiratory pathogen testing has been a common deimplementation focus. The COVID-19 pandemic brought new considerations for respiratory testing; recent trends in testing rates are not well understood.
Objective:
To measure trends in respiratory testing among encounters for acute respiratory infections among children and adolescents (aged <18 years) from 2016 to 2023, assess the association of COVID-19 with these trends, and describe associated cost trends.
Design, Setting, And Participants:
This retrospective serial cross-sectional study included emergency department (ED) encounters and hospitalizations in US children's hospitals among children and adolescents with a primary acute infectious respiratory illness diagnosis. Data were ascertained from the Pediatric Health Information System database from January 1, 2016, to December 31, 2023.
Exposure:
Respiratory pathogen testing.
Main Outcomes And Measures:
The primary outcome was the percentage of encounters with respiratory testing over time. Interrupted time series models were created to assess the association of COVID-19 with testing patterns. The inflation-adjusted standardized unit cost associated with respiratory testing was also examined.
Results:
There were 5 090 923 eligible encounters among patients who were children or adolescents (mean [SD] age, 3.36 [4.06] years); 55.0% of the patients were male. Among these encounters, 87.5% were ED only, 77.9% involved children younger than 6 years, and 94.5% involved children without complex chronic conditions. Respiratory testing was performed in 37.2% of all encounters. The interrupted time series models demonstrated increasing prepandemic testing rates in both ED-only encounters (slope, 0.26 [95% CI, 0.21-0.30]; P < .001) and hospitalizations (slope, 0.12 [95% CI, 0.07-0.16]; P < .001). Increases in respiratory testing were seen at the onset of the COVID-19 pandemic in both ED-only encounters (level change, 33.78 [95% CI, 31.77-35.79]; P < .001) and hospitalizations (level change, 30.97 [95% CI, 29.21-32.73]; P < .001), associated initially with COVID-19-only testing. Postpandemic testing rates remained elevated relative to prepandemic levels. The percentage of encounters with respiratory testing increased from 13.6% [95% CI, 13.5%-13.7%] in 2016 to a peak of 62.2% [95% CI, 62.1%-62.3%] in 2022. While COVID-19-only testing decreased after 2020, other targeted testing and large-panel (>5 targets) testing increased. The inflation-adjusted standardized unit cost associated with respiratory testing increased from $34.2 [95% CI, $33.9-$34.6] per encounter in 2017 to $128.2 [95% CI, $127.7-$128.6] per encounter in 2022.
Conclusions And Relevance:
The findings of this cross-sectional study suggest that respiratory testing rates have increased over time, with large increases at the onset of the COVID-19 pandemic that have persisted. Respiratory testing rates and related costs increased significantly, supporting a need for future deimplementation efforts.
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