The Clinical Utility of Respiratory Viral Testing in Hospitalized Children: A Meta-analysis

Noël, Kim C.; Fontela, Patricia; Winters, Nicholas; Quach, Caroline; Gore, Geneviève; Robinson, Joan; Dendukuri, Nandini; Papenburg, Jesse

doi:10.1542/hpeds.2018-0233

Cited by 15 publications

(8 citation statements)

References 56 publications

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“…20 However, single-center studies and a systematic review and meta-analysis have demonstrated discordant results for the benefit of viral testing on these outcomes in children hospitalized with respiratory illnesses. [21][22][23][24] In our analysis, the average length of stay and average duration of antibiotics during hospitalization were both ~2 days, and viral testing was not associated with these outcomes at the hospital level.…”

Section: Hospital-level Testing and Outcomesmentioning

confidence: 99%

Respiratory virus testing and clinical outcomes among children hospitalized with pneumonia

Shapiro

Thurm

Hall

et al. 2022

Journal of Hospital Medicine

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Background: Despite the increased availability of diagnostic tests for respiratory viruses, their clinical utility for children with community-acquired pneumonia (CAP) remains uncertain. Objective: To identify patterns of respiratory virus testing across children's hospitals prior to the COVID-19 pandemic and to determine whether hospital-level rates of viral testing were associated with clinical outcomes. Design, Setting, and Participants: Multicenter retrospective cohort study of children hospitalized for CAP at 19 children's hospitals in the United States from 2010-2019. Main Outcomes and Measures: Using a novel method to identify the performance of viral testing, we assessed time trends in the use of viral tests, both overall and stratified by testing method. Adjusted proportions of encounters with viral testing were compared across hospitals and were correlated with length of stay, antibiotic and oseltamivir use, and performance of ancillary laboratory testing.Results: There were 46,038 hospitalizations for non-severe CAP among children without complex chronic conditions. The proportion with viral testing increased from 38.8% to 44.2% during the study period (p < .001). Molecular testing increased (27.2% to 40.0%, p < .001) and antigen testing decreased (33.2% to 7.8%, p < .001).Hospital-specific adjusted proportions of testing ranged from 10.0% to 83.5% and were not associated with length of stay, antibiotic use, or antiviral use. Hospitals that performed more viral testing did not have lower rates of ancillary laboratory testing.Conclusions: Viral testing practices varied widely across children's hospitals and were not associated with clinically important process or outcome measures. Viral testing may not influence clinical management for many children hospitalized with CAP.

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Section: Hospital-level Testing and Outcomesmentioning

confidence: 99%

Respiratory virus testing and clinical outcomes among children hospitalized with pneumonia

Shapiro

Thurm

Hall

et al. 2022

Journal of Hospital Medicine

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“… 4 , 10 , 11 However, the impact of viral diagnostic testing on antibiotic administration for children with ARI remains unclear due to conflicting results, with some studies reporting that viral diagnostics are associated with lower antibiotic use, while others report no impact. 12 , 13 Likewise, studies examining viral testing and antibiotic prescribing and administration practices in both EDs and inpatient settings are limited. Therefore, in this prospective study, we aimed to evaluate the association of (1) provider-ordered viral testing and antibiotic treatment, and (2) provider-ordered viral test result (ie, positive, negative) and antibiotic treatment among children presenting to an ED or hospitalized with an ARI at major tertiary care children’s hospital in Nashville, Tennessee.…”

Section: Introductionmentioning

confidence: 99%

Provider-ordered viral testing and antibiotic administration practices among children with acute respiratory infections across healthcare settings in Nashville, Tennessee

Rankin,

Katz,

Amarin

et al. 2024

ASHE

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Objective: Evaluate the association between provider-ordered viral testing and antibiotic treatment practices among children discharged from an ED or hospitalized with an acute respiratory infection (ARI). Design: Active, prospective ARI surveillance study from November 2017 to February 2020. Setting: Pediatric hospital and emergency department in Nashville, Tennessee. Participants: Children 30 days to 17 years old seeking medical care for fever and/or respiratory symptoms. Methods: Antibiotics prescribed during the child’s ED visit or administered during hospitalization were categorized into (1) None administered; (2) Narrow-spectrum; and (3) Broad-spectrum. Setting-specific models were built using unconditional polytomous logistic regression with robust sandwich estimators to estimate the adjusted odds ratios and 95% confidence intervals between provider-ordered viral testing (ie, tested versus not tested) and viral test result (ie, positive test versus not tested and negative test versus not tested) and three-level antibiotic administration. Results: 4,107 children were enrolled and tested, of which 2,616 (64%) were seen in the ED and 1,491 (36%) were hospitalized. In the ED, children who received a provider-ordered viral test had 25% decreased odds (aOR: 0.75; 95% CI: 0.54, 0.98) of receiving a narrow-spectrum antibiotic during their visit than those without testing. In the inpatient setting, children with a negative provider-ordered viral test had 57% increased odds (aOR: 1.57; 95% CI: 1.01, 2.44) of being administered a broad-spectrum antibiotic compared to children without testing. Conclusions: In our study, the impact of provider-ordered viral testing on antibiotic practices differed by setting. Additional studies evaluating the influence of viral testing on antibiotic stewardship and antibiotic prescribing practices are needed.

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“…Currently, viral ARIs are often identified with point-of-care antigen tests or novel molecular diagnostic assays, but, these tests can be costly and not readily accessible to many healthcare settings worldwide 6–8. This challenge requires clinicians to infer ARI aetiologies based on clinical features, which is prone to diagnostic uncertainty as viral and bacterial ARI symptoms overlap 9 10. In an attempt to increase diagnostic certainty, researchers developed several prediction models to facilitate diagnosis of viral ARIs.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic models predicting paediatric viral acute respiratory infections: a systematic review

et al. 2023

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ObjectivesTo systematically review and evaluate diagnostic models used to predict viral acute respiratory infections (ARIs) in children.DesignSystematic review.Data sourcesPubMed and Embase were searched from 1 January 1975 to 3 February 2022.Eligibility criteriaWe included diagnostic models predicting viral ARIs in children (<18 years) who sought medical attention from a healthcare setting and were written in English. Prediction model studies specific to SARS-CoV-2, COVID-19 or multisystem inflammatory syndrome in children were excluded.Data extraction and synthesisStudy screening, data extraction and quality assessment were performed by two independent reviewers. Study characteristics, including population, methods and results, were extracted and evaluated for bias and applicability using the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies and PROBAST (Prediction model Risk Of Bias Assessment Tool).ResultsOf 7049 unique studies screened, 196 underwent full text review and 18 were included. The most common outcome was viral-specific influenza (n=7; 58%). Internal validation was performed in 8 studies (44%), 10 studies (56%) reported discrimination measures, 4 studies (22%) reported calibration measures and none performed external validation. According to PROBAST, a high risk of bias was identified in the analytic aspects in all studies. However, the existing studies had minimal bias concerns related to the study populations, inclusion and modelling of predictors, and outcome ascertainment.ConclusionsDiagnostic prediction can aid clinicians in aetiological diagnoses of viral ARIs. External validation should be performed on rigorously internally validated models with populations intended for model application.PROSPERO registration numberCRD42022308917.

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The Clinical Utility of Respiratory Viral Testing in Hospitalized Children: A Meta-analysis

Cited by 15 publications

References 56 publications

Respiratory virus testing and clinical outcomes among children hospitalized with pneumonia

Respiratory virus testing and clinical outcomes among children hospitalized with pneumonia

Provider-ordered viral testing and antibiotic administration practices among children with acute respiratory infections across healthcare settings in Nashville, Tennessee

Diagnostic models predicting paediatric viral acute respiratory infections: a systematic review

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