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Impact of the COVID-19 Pandemic on Viral Respiratory Testing in Children With Abnormal Urinalysis

Grace Truong1, Sowdhamini S Wallace1, Duc T Nguyen2

  • 1Division of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.

Hospital Pediatrics
|August 12, 2026
PubMed

Insights

Respiratory viral panels (RVP) use significantly increased in children with abnormal urinalysis (UA) during and after the COVID-19 pandemic. This costly testing showed low antiviral use, indicating a need for better diagnostic stewardship.

Area of Science:

  • Pediatric Emergency Medicine
  • Infectious Diseases
  • Diagnostic Testing

Background:

  • Respiratory viral panels (RVP) are frequently used in pediatric emergency departments.
  • The utility of RVP in children with abnormal urinalysis (UA) results, particularly for non-respiratory conditions, is questionable.
  • Pre-existing overuse of RVP was hypothesized to increase following the COVID-19 pandemic.

Purpose of the Study:

  • To evaluate the trends in RVP utilization among children aged 0-24 months with abnormal UA results before, during, and after the COVID-19 pandemic.
  • To assess the impact of RVP testing on treatment decisions, specifically antiviral use, and associated healthcare costs.

Main Methods:

  • A retrospective cohort study was conducted on 7496 children (0-24 months) with abnormal UA results presenting to a pediatric ED.
  • Data were collected for three periods: prepandemic (March 2018-February 2020), pandemic (March 2020-May 2023), and postpandemic (July 2023-May 2025).
  • Interrupted time series analysis examined RVP testing trends, with secondary outcomes including ED revisits, antiviral use, and costs.

Main Results:

  • RVP testing increased from 25.0% prepandemic to 68.1% during the pandemic and remained high at 66.1% postpandemic.
  • There was a significant increase in RVP use during the pandemic compared to prepandemic (P < .001), with no significant change between pandemic and postpandemic periods (P = .14).
  • RVP testing was associated with no difference in ED revisits (P = .41), low antiviral use (1.8%), and a total cost of $1,037,978.

Conclusions:

  • RVP testing in children with abnormal UA results surged during the COVID-19 pandemic and persisted postpandemic.
  • The high cost and limited impact on antiviral prescribing highlight significant opportunities for improving diagnostic stewardship.
  • Optimizing RVP utilization in this population is crucial for resource management and appropriate patient care.
Abstract

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