Evaluating the Impact of Respiratory Pathogen Testing on Pediatric Emergency Department Return Visits and Management

To determine whether limited versus comprehensive respiratory pathogen panel (RPP) testing in children discharged from the pediatric emergency department (PED) with a viral respiratory illness is associated with 7-day PED return visit rate and return visit management and disposition.

We conducted a retrospective cohort study of children 61 days to 18 years of age discharged from a large urban PED between June 1, 2023 to August 31, 2023 and December 1, 2023 to February 29, 2024, who received either limited (SARS-CoV-2, influenza A/B, respiratory syncytial virus) or comprehensive (22 pathogens) RPP testing for a clinically diagnosed viral respiratory illness. We recorded basic demographics, RPP test results, 7-day PED returns, and interventions and disposition during return visits.

Of 2346 eligible patients, 1417 (60.4%) received limited RPP testing and 929 (39.6%) received comprehensive RPP testing. No difference was found in the 7-day PED return visit rate for limited testing compared with comprehensive testing after controlling for age, sex, race/ethnicity, insurance, Emergency Severity Index level, and visit season (aOR: 0.96, 95% CI: 0.67-1.38). On return visits, patients who had received limited testing were more likely to undergo additional urine studies (aOR: 2.70, 95% CI: 1.16-6.84); no differences were found in additional blood tests, throat swabs, chest radiographs, IV placements, medication administration, antibiotic prescribing, or disposition.

Limited RPP testing is likely sufficient for children with a viral respiratory illness in the outpatient setting, as comprehensive RPP testing was not associated with a reduction in 7-day return visits or return visit interventions.