Trends in Respiratory Pathogen Testing at US Children's Hospitals

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.