Intérêt de l’identification en routine des agents pathogènes respiratoires chez les enfants hospitalisés pour une exacerbation d’asthme

Sauvaget, E.; Bresson, V.; Oudyi, M.; Bosdure, E.; Loundou, Anderson; Chabrol, B.; Charrel, Rémi N.; Dubus, J.‐C.

doi:10.1016/j.arcped.2014.08.024

Cited by 2 publications

(2 citation statements)

References 17 publications

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“…With its high economic burden, it is considered a disease of major public health importance by the World Health Organization [2]. The Global Initiative for Asthma estimated that 300 million people worldwide had asthma in 2004, and projected that this number would increase to 400 million by 2025 as countries became more urbanized [3].…”

Section: Introductionmentioning

confidence: 99%

“…The Global Initiative for Asthma estimated that 300 million people worldwide had asthma in 2004, and projected that this number would increase to 400 million by 2025 as countries became more urbanized [3]. The link between respiratory tract infections and acute asthma exacerbation has been recognized and well documented [2, 4]. Those with asthma tend to suffer from more severe consequences of respiratory tract infections [5], including influenza, rhinovirus (RV), and respiratory syncytial virus (RSV) [4].…”

Section: Introductionmentioning

confidence: 99%

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Temporal trends and factors associated with pediatric hospitalizations with respiratory infection

2015

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Objectives Asthma is the leading cause of emergency room visits in children, and those with asthma tend to suffer from more severe consequences of respiratory tract infections. The aims of this study were among children who required hospitalization, compare differences between those admitted with or without respiratory infection, describe changes in yearly proportion of asthma among the children admitted with a respiratory infection in New York City from 2006 to 2012, and ascertain how asthma affected the average length of hospital stay for those with respiratory infection. Methods We conducted an historical prospective study using data obtained from multiple electronic sources of patients discharged from a 200 bed pediatric hospital in a major metropolitan healthcare system between 2006 and 2012. Patient characteristics were obtained from electronic health records and billing codes. Results Among 83,348 patient discharges, there were 5,057 (6.1%) with a respiratory infection. In the multivariable model, children with the following characteristics were significantly more likely to be admitted with a respiratory infection as compared with other diagnoses: asthma [odds ratio (OR) 4.68 (95% confidence limits (CL): 4.31, 5.08], male sex [OR:1.11 (1.05, 1.18)], prior hospitalization [OR: 3.65 (3.43, 3.89)], renal failure [(OR: 2.14 (1.70, 2.70)], and Medicaid coverage [OR: 1.93 (1.81, 2.05)]. Children ≥age 5 years (OR: 0.44 (0.41, 0.47) and those with diabetes (OR: 0.32 (0.21, 0.51) were less likely to be admitted with a respiratory infection. Hospitalized patients with respiratory infection and asthma, identified by ICD-9 codes, had significantly shorter lengths of stay than patients without asthma, 5.3 and 9.0 days, respectively, p<0.001. Asthma in patients admitted with a respiratory infection increased from 19.2% in 2006 to 28.2% in 2012, peaking at 34.1% in 2010 (p<0.001). Conclusion This study suggests that asthma is a significant risk factor for hospitalization of children with respiratory infection, and suggests that the prevalence of asthma is increasing over time among children hospitalized with respiratory infection in this urban setting.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Temporal trends and factors associated with pediatric hospitalizations with respiratory infection

2015

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Do I Need Proof of the Culprit? Decreasing Respiratory Viral Testing in Critically Ill Patients

Innis¹,

Hasson²,

Bodilly³

et al. 2021

Hospital Pediatrics

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A 2-year-old, previously healthy boy with an upper respiratory infection presents to the emergency department with acute-onset stridor and respiratory distress. He quickly improves with intramuscular dexamethasone and initiation of heliox via high-flow nasal cannula. He is admitted to the PICU for respiratory insufficiency, requiring heliox, and high risk of respiratory failure. Before calling the PICU team for admission, the emergency department resident sends a respiratory viral polymerase chain reaction (PCR) panel. When her attending questions its necessity, she answers, "They [PICU admitting team] will ask for it. They always want to know which bug it is." Historically, at our institution, respiratory viral PCR panels were commonly ordered for patients with more severe disease requiring PICU admission to find the culprit virus. Local practice had evolved to sending respiratory viral PCR tests for the majority of PICU patients with respiratory complaints, even before admission.Since its introduction, respiratory viral PCR panel-testing proponents have advocated its use to reduce unnecessary health care resource use. [1][2][3] However, studies in which authors evaluate the clinical impact of respiratory viral PCR panel testing have varied in their results and lacked consistent evidence to support changes in management or outcomes, including antibiotic administration, chest radiographic imaging, hospital admission, and hospital length of stay. [3][4][5][6][7] In addition, commonly held beliefs include the need to test for isolation and cohort practices or to identify treatable viruses. The Choosing Wisely guidelines of the American Society for Clinical Pathology recommend against routine, broad respiratory viral PCR panels on the basis of the evidence and, in place, recommend specific rapid molecular tests that impact management, such as respiratory syncytial virus (RSV) or influenza A and B testing. 8,9 In critically ill pediatric patients, current evidence does not support routine testing for common diagnoses, such as status asthmaticus or bronchiolitis. 8,10 We aim to "bend the value curve" 11 through a pediatric critical care fellow-led quality improvement project addressing overuse of respiratory viral PCR testing. The primary specific aim was to reduce respiratory viral PCR panel testing per PICU patient day in a 35-bed, medical-surgical PICU at Cincinnati Children' s Hospital Medical Center by 30% within 1 year and demonstrate sustainability. We selected a 30% overall reduction because of the necessity for extended respiratory viral PCR panel testing in specific PICU populations for prognostication and treatment. The secondary specific aim was to reduce patient charges for viral respiratory testing within the PICU, defined as patient charges per patient day. The balancing metrics were rate of rapid molecular testing (RSV, influenza A and B, pertussis and/or parapertussis), rate of total overall respiratory viral testing (respiratory viral PCR panel and rapid

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Intérêt de l’identification en routine des agents pathogènes respiratoires chez les enfants hospitalisés pour une exacerbation d’asthme

Cited by 2 publications

References 17 publications

Temporal trends and factors associated with pediatric hospitalizations with respiratory infection

Temporal trends and factors associated with pediatric hospitalizations with respiratory infection

Do I Need Proof of the Culprit? Decreasing Respiratory Viral Testing in Critically Ill Patients

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