Pediatric Patients Hospitalized for Community Acquired Respiratory Viral Infections – Comparison of Virus-Specific Mortality, Length of Stay, and Hospital Charges
Background: Respiratory viral (RV) infection is one of the most common illnesses, causing more yearly doctor visits and absences from school and work than any other illness. The viruses involved may be respiratory adenoviruses (Adeno), parainfluenza (paraflu) viruses, human metapneumovirus (HMPV), influenza (Flu) viruses, respiratory syncytial virus (RSV), and rhinoviruses (Rhino). This study described and compared the clinical and financial impact of these infections in a pediatric hospital serving the District of Columbia metropolitan area.
Methods: This cohort study included children and adolescents admitted to the institution between 9/2011 and 12/2013 for a community-acquired RV infection, defined as the isolation of one or more respiratory viral pathogens detected in Nasopharyngeal aspirates using multiplex PCR, in patients with clinical symptoms within four days of admission. Information on patient demographic, discharge diagnoses, length of stay (LOS), intensive care unit (ICU) admission and LOS, and discharge disposition was extracted from the hospital's administrative database. A patient that had greater than 1 RV detected in one specimen was excluded from the analysis.
Results: The study identified 2905 patients who encountered 3666 hospitalizations resulting in a total of 25,151 days LOS and $2.86 million hospital charges. Nearly 30% (29.5%) of patients were admitted to the ICU for a total LOS in the ICU of 6,852 days. Thirty-three (0.9%) patients died during the hospitalization. The majority of hospitalizations was due to Rhino/enterovirus (48.7%), followed by RSV (25.7%). The average hospital charges per hospitalization were the highest in Flu (Type B) followed by HMPV. The proportion of ICU admissions was the greatest in HMPV (37.8%) followed by Flu (Type A, H1N1 pandemic 2009) (36.0%). The case-fatality rate was the highest in Adeno (2.1%) followed by HMPV and paraflu infections (1.5%).
Conclusion: This study demonstrated that RV infections in pediatric patients are associated with substantial healthcare expenses. It remains prudent to improve measures such as public vaccination and education to reduce severe infections that would require medical attentions and hospitalizations.