Acute viral bronchiolitis is responsible for over 150,000 pediatric admissions per year in the United States. Respiratory syncytial virus (RSV) testing is frequently performed in this population. However, there are few studies addressing whether the results of this test impact the management of patients hospitalized with bronchiolitis, specifically regarding the rate of chest imaging or antibiotic use.
We conducted a retrospective cohort study involving electronic chart review of patients 024 months of age hospitalized for bronchiolitis, as determined by ICD9 codes, in an inner city tertiary care children’s hospital. Patients were excluded, if they had known comorbid conditions that could increase their risk of pneumonia, such as congenital heart disease, bronchopulmonary dysplasia, tracheostomy, cystic fibrosis, sickle cell disease, immunodeficiency, neuromuscular impairment, or malignancy. Demographic, clinical, microbiologic, and radiologic data were extracted both manually and using an interactive data collection tool, Clinical Looking Glass. Chisquare test was used to compare patients who tested positive for RSV on nasopharyngeal swab by enzymelinked immunosorbent assay with those who tested negative, to assess the relative rates of chest radiography and antibiotic administration. Data were analyzed using SPSS software.
A total of 526 patients between January 2007 and December 2008 met criteria for inclusion. Mean age on admission was 6.5 months, and average length of stay was 3.57 days. Rapid RSV testing was performed on 462 patients (88%). Of these, 183 patients had a positive test for RSV (40%). Chest radiography was performed on 113 of 183 (62%) RSV positive patients compared with 203 of 279 (73%) RSV negative patients (p = 0.013). Antibiotics were prescribed for any cause to 71 of 183 (39%) RSV positive patients compared with 105 of 279 (38%) RSV negative patients (p = 0.77).
RSV positivity was associated with decreased utilization of chest radiography in acute bronchiolitis but not with decreased antibiotic use. As with all retrospective studies, this association does not prove causality. Further study is warranted as to whether RSV testing may reduce unnecessary chest radiography in bronchiolitis, thereby potentially reducing radiation exposure and cost for a subgroup of patients admitted with bronchiolitis.
To cite this abstract:Azzarone G, Agalliu I, Nazif J, Esteban N, Biller R, Liewehr S. Rsv Antigen Testing: Clinically Relevant or Mere Academic Exercise?. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97568. https://www.shmabstracts.com/abstract/rsv-antigen-testing-clinically-relevant-or-mere-academic-exercise/. Accessed December 10, 2018.