By Marcus A. Banks
Pediatricians at Children’s Hospital Los Angeles and University of Southern California have developed a more cost-effective way to determine whether a child has a respiratory tract infection (RTI). They presented their work at the ASM Microbe 2025 meeting, in Los Angeles (poster session CIV-P-202. CIV05).
An RTI is one of the most common reasons children present to the emergency department (ED). A respiratory viral panel (RVP) can be essential in diagnosing an RTI, the researchers noted, especially as these panels deliver results quickly. But RVPs are costly and burdensome for children and hospitals alike if offered indiscriminately, the researchers added, prompting their study of which types of patients should receive an RVP.
The researchers retrospectively evaluated the records of 400 patients, 5 years of age and younger, who received an RVP panel after visiting an ED. Half of the panel results were positive, meaning a respiratory virus was present; the other half were negative.
Almost all children (93%) had no medical history before receiving the RVP, and having a fever in itself was not associated with a positive RVP result.
Positive RVP results were significantly correlated with several RTI symptoms, including cough (P<0.0101), nasal congestion (P<0.0001), rhinorrhea (P<0.0001) and dyspnea (P<0.0231). These correlations were perhaps as to be expected, and relying on this evidence alone would have still meant overuse of RVP tests. So researchers tested whether additional criteria would eliminate some unnecessary RVPs.
These criteria included being a neonate (<60 days old) with a documented fever (38°C), being critically ill or immunocompromised with fever and/or RTI symptoms, and/or a documented fever for at least five days.
Adding these criteria in the decision to order an RVP would have eliminated the need for 52% of negative tests while retaining 82% of positive tests (P<0.0001), saving money and time.
“We found a significant reduction of unnecessary testing in the ED when criteria were applied to a retrospective cohort of patients. Further studies are needed to establish stewardship guidelines across pediatric institutes to provide cost-effective RVP testing,” the researchers said.
