Impact of Enteroviral Polymerase Chain Reaction Testing on Length of Stay for Infants 60 Days Old or Younger

• Type of Material: Article
• Authors: Paul L. Aronson, Yale School of Medicine; Todd W. Lyons, Boston Childrens Hospital; Andrea T. Cruz, Baylor College of Medicine; Stephen B. Freedman, University of Calgary; Pamela J. Okada, University of Texas Southwestern; Alesia Fleming, Emory University; Joseph L. Arms, Children's Hospital and Clinic of Minnesota; Amy D. Thompson, Nemours/Alfred I. duPont Hospital for Children; Suzanne M. Schmidt, Northwestern University; Jeffrey Louie, University of Minnesota; Michael J. Alfonzo, Yale School of Medicine; Michael C. Monuteaux, Boston Childrens Hospital; Lise E. Nigrovic, Boston Childrens Hospital
• Language: English
• Date: 2017-10-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jpeds.2017.06.021
• Title of Journal or Parent Work: Journal of Pediatrics
• ISSN: 0022-3476
• Volume: 189
• Start Page: 169
• End Page: +
• Grant/Funding Information: Stephen Freedman is supported by the Alberta Children’s Hospital Foundation Professorship in Child Health and Wellness.; Todd W. Lyons was supported by a training grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NIH) Childhood (5T32HD040128-12).; Paul L. Aronson received support for this work from CTSA grant number KL2 TR001862 from the National Center for Advancing Translational Science (NCATS), a component of the National Institutes of Health (NIH).; Supported by the Section of Emergency Medicine of the American Academy of Pediatrics (AAP) and Baylor College of Medicine.
• Keywords: AGE; RISK; CHILDREN; FEVER; SERIOUS BACTERIAL-INFECTION; Science & Technology; MENINGITIS; ASSOCIATION; Life Sciences & Biomedicine; FEBRILE INFANTS; DIAGNOSIS; Pediatrics; PATIENT-MANAGEMENT
• Research Categories: Health Sciences, Health Care Management; Education, Technology

Abstract

Objective To determine the impact of a cerebrospinal fluid enterovirus polymerase chain reaction (PCR) test performance on hospital length of stay (LOS) in a large multicenter cohort of infants undergoing evaluation for central nervous system infection. Study design We performed a planned secondary analysis of a retrospective cohort of hospitalized infants ≤60 days of age who had a cerebrospinal fluid culture obtained at 1 of 18 participating centers (2005-2013). After adjustment for patient age and study year as well as clustering by hospital center, we compared LOS for infants who had an enterovirus PCR test performed vs not performed and among those tested, for infants with a positive vs negative test result. Results Of 19 953 hospitalized infants, 4444 (22.3%) had an enterovirus PCR test performed and 945 (21.3% of tested infants) had positive test results. Hospital LOS was similar for infants who had an enterovirus PCR test performed compared with infants who did not (incident rate ratio 0.98 hours; 95% CI 0.89-1.06). However, infants PCR positive for enterovirus had a 38% shorter LOS than infants PCR negative for enterovirus (incident rate ratio 0.62 hours; 95% CI 0.57-0.68). No infant with a positive enterovirus PCR test had bacterial meningitis (0%; 95% CI 0-0.4). Conclusions Although enterovirus PCR testing was not associated with a reduction in LOS, infants with a positive enterovirus PCR test had a one-third shorter LOS compared with infants with a negative enterovirus PCR test. Focused enterovirus PCR test use could increase the impact on LOS for infants undergoing cerebrospinal fluid evaluation.