Objective: Describe the characteristics and outcomes of pediatric patients with a positive RVP and the situations in which the results are used.
Methods: A retrospective review was conducted on patients with a positive RVP between Oct 1, 2013 and Apr 30, 2014. Included patients were born after 1995 and had an RVP collected while admitted to the pediatric hospital. Charts were reviewed to identify the clinical scenario that lead to obtaining RVP and the clinical decision that resulted from the positive result.
Results: Between October 1, 2013 and April 30, 2014 398 RVPs were obtained in pediatric patients, of those 190 were positive. Median age was 22 months and 61% were male. Rhinovirus was the most common virus identified; 63% were positive. Other viruses with high prevalence included RSV and coronaviruses both with 13% prevalence. Most frequent reasons for ordering an RVP were: new respiratory symptoms or decline in respiratory status (57%); new fever (17%); defining a viral cause of symptoms vs. other non-infectious causes (<10%). RVP results confirmed management in 26% of patients and changed management in 24%, and these changes frequently were hospital discharge and/or discontinuing antibiotics. Other changes included delaying surgical procedures, treatment such as IVIG, oseltamivir or ribavirin. The most common reason for disregarding RVP results was ongoing concern for or radiological evidence suggestive of a bacterial process.
Conclusion: In our study, a positive RVP result led to beneficial outcomes in 50% of clinical situations. With thoughtful use, the RVP can be both clinically useful and likely cost-effective. Future studies will focus on educating providers on situations that maximize the clinical utility of RVP testing.
L. A. Cioffredi,
R. Jhaveri, GenMark: Investigator , Research grant