Risk factors for disease severity and increased medical resource utilization in respiratory syncytial virus (+) hospitalized children: A descriptive study conducted in four Belgian hospitals

Abstract

Background We aimed to provide regional data on clinical symptoms, medical resource utilization (MRU), and risk factors for increased MRU in hospitalized respiratory syncytial virus (RSV)-infected Belgian pediatric population. Methods This prospective, multicenter study enrolled RSV (+) hospitalized children (aged ≤5y) during the 2013–2015 RSV seasons. RSV was diagnosed within 24h of hospitalization. Disease severity of RSV (+) patients was assessed until discharge or up to maximum six days using a Physical Examination Score (PES) and a derived score based on ability to feed, dyspnea and respiratory effort (PES3). MRU (concomitant medications, length of hospitalization [LOH], and oxygen supplementation) was evaluated. Kaplan-Meier survival analysis was performed to compare MRU by age and presence of risk factors for severe disease. Association between baseline covariates and MRU was analyzed using Cox regression models. Results In total, 75 children were included, Median (range) age was 4 (0–41) months, risk factors were present in 18.7%, and early hospitalization (≤3 days of symptom onset) was observed in 57.3% of patients. Cough (100%), feeding problems (82.2%), nasal discharge (87.8%), and rales and rhonchi (82.2%) were frequently observed. Median (range) LOH and oxygen supplementation was 5 (2–7) and 3 (1–7) days. Oxygen supplementation, bronchodilators, and antibiotics were administered to 58.7%, 64.0%, and 41.3% of the patients, respectively. Age <3 months and baseline total PES3 score were associated with probability and the duration of receiving oxygen supplementation. LOH was not associated with any covariate. Conclusion RSV is associated with high disease burden and MRU in hospitalized children. Oxygen supplementation but not length of hospitalization was associated with very young age and the PES3 score. These results warrant further assessment of the PES3 score as a predictor for the probability of receiving and length of oxygen supplementation in RSV hospitalized children. Registration NCT02133092

RSV‐CLASS —Clinical Assessment Severity Score: An easy‐to‐use clinical disease severity score for respiratory syncytial virus infection in hospitalized children

“…Third, rales are a common sign of lower respiratory tract involvement and were reported to occur most frequently in RSV‐positive hospitalized children under 6 months 37 …”

“…36 It is also reported as the most common symptom in hospitalized children in other RSV studies. 31,37 Second, respiratory rate is an essential clinical tool in assessing children 38,39 and a sign of respiratory distress. 12,13,22,40 As it is considered a predictor of LRTI and patient deterioration, it is helpful for clinical evaluation and decision-making regarding hospital admission.…”

“…Third, rales are a common sign of lower respiratory tract involvement and were reported to occur most frequently in RSVpositive hospitalized children under 6 months. 37 Fourth, wheezing is the leading clinical symptom of obstructive bronchitis and bronchiolitis. 44,45 Both rales and wheezing are auscultatory findings due to the turbulent airflow and vibration of the conducting airways during an infection.…”

Increased Heme Oxygenase 1 Expression upon a Primary Exposure to the Respiratory Syncytial Virus and a Secondary Mycobacterium bovis Infection

“…Human respiratory syncytial virus (hRSV) is the leading cause of acute lower respiratory tract infection (ALRTI) in children under five-year-old, displaying high rates of hospitalization and over 90,000 death-related cases [ 1 , 2 ]. Children under two years of age, people with comorbidities, such as cardiac and pulmonary affections, and the elderly, are the most susceptible to developing hRSV bronchiolitis and pneumonia [ 3 ].…”