Department of Pediatrics, Vanderbilt University, Nashville, TN, USA.
Pediatr Infect Dis J. 2013 May;32(5):467-72. doi: 10.1097/INF.0b013e318284b146.
Respiratory viral panels (RVPs) able to detect multiple pathogens are increasingly used in the management of pediatric inpatients. Despite this, few studies have examined whether the results of these tests are associated with clinically significant changes in medical management.
In this retrospective cohort study, we identified pediatric inpatients between August 2009 and December 2010 for whom an RVP was ordered within 24 hours of admission to a large, tertiary-care children's hospital. We used linear regression to determine whether RVP was associated with length of stay (LOS), duration of antibiotics and the number of diagnostic microbiology tests ordered, adjusting for potential confounders.
We found that the association between results of the RVP and LOS was dependent on a patient's admission service, specifically admission to the hematology/oncology service. We also found that patients with a positive RVP had a shorter duration of intravenous antibiotic administration (P = 0.03; 42% reduction in the geometric mean), but that this was influenced by the primary admission service. We also found that positive results of the RVP were associated with decreased LOS and shorter duration of antibiotics in patients with some common respiratory diagnoses.
This study lacked sufficient evidence to claim an association between a positive RVP and LOS in pediatric patients, adjusting for their underlying diagnosis. However, we found that a positive RVP was associated with a shorter duration of intravenous antibiotic administration in certain groups of patients and those with some common respiratory diagnoses. These findings help clarify the utility of rapid viral testing in the management of hospitalized pediatric patients.
能够检测多种病原体的呼吸道病毒检测试剂盒(RVPs)在儿科住院患者的管理中越来越多地被使用。尽管如此,很少有研究检查这些检测结果是否与医疗管理中具有临床意义的变化相关。
在这项回顾性队列研究中,我们确定了 2009 年 8 月至 2010 年 12 月期间在一家大型三级儿童医院住院的儿科住院患者,他们在入院后 24 小时内接受了 RVP 检测。我们使用线性回归来确定 RVP 是否与住院时间(LOS)、抗生素使用时间以及所开诊断性微生物学检测的数量相关,同时调整了潜在的混杂因素。
我们发现 RVP 结果与 LOS 的相关性取决于患者的入院科室,特别是血液科/肿瘤科。我们还发现,RVP 阳性的患者静脉用抗生素治疗时间更短(P=0.03;几何均数减少 42%),但这受到主要入院科室的影响。我们还发现,在某些常见呼吸道疾病患者中,RVP 阳性结果与 LOS 缩短和抗生素使用时间缩短有关。
本研究缺乏足够的证据来证明在儿科患者中,在调整其基础诊断后,RVP 阳性与 LOS 之间存在关联。然而,我们发现 RVP 阳性与某些患者群体和某些常见呼吸道疾病患者的静脉用抗生素治疗时间缩短有关。这些发现有助于阐明快速病毒检测在住院儿科患者管理中的作用。