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

Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus (HSV) Study Group

Research output: Contribution to journalArticle

8 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)169-174.e2
JournalJournal of Pediatrics
Volume189
DOIs
StatePublished - Oct 1 2017

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Enterovirus
Length of Stay
Polymerase Chain Reaction
Cerebrospinal Fluid
Central Nervous System Infections
Bacterial Meningitides
Cluster Analysis

Keywords

  • enterovirus
  • meningitis
  • neonate
  • young infant

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus (HSV) Study Group (2017). Impact of Enteroviral Polymerase Chain Reaction Testing on Length of Stay for Infants 60 Days Old or Younger. Journal of Pediatrics, 189, 169-174.e2. https://doi.org/10.1016/j.jpeds.2017.06.021

Impact of Enteroviral Polymerase Chain Reaction Testing on Length of Stay for Infants 60 Days Old or Younger. / Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus (HSV) Study Group.

In: Journal of Pediatrics, Vol. 189, 01.10.2017, p. 169-174.e2.

Research output: Contribution to journalArticle

Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus (HSV) Study Group 2017, 'Impact of Enteroviral Polymerase Chain Reaction Testing on Length of Stay for Infants 60 Days Old or Younger', Journal of Pediatrics, vol. 189, pp. 169-174.e2. https://doi.org/10.1016/j.jpeds.2017.06.021
Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus (HSV) Study Group. Impact of Enteroviral Polymerase Chain Reaction Testing on Length of Stay for Infants 60 Days Old or Younger. Journal of Pediatrics. 2017 Oct 1;189:169-174.e2. https://doi.org/10.1016/j.jpeds.2017.06.021
Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus (HSV) Study Group. / Impact of Enteroviral Polymerase Chain Reaction Testing on Length of Stay for Infants 60 Days Old or Younger. In: Journal of Pediatrics. 2017 ; Vol. 189. pp. 169-174.e2.
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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.",
keywords = "enterovirus, meningitis, neonate, young infant",
author = "{Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus (HSV) Study Group} and Aronson, {Paul L.} and Lyons, {Todd W.} and Cruz, {Andrea T.} and Freedman, {Stephen B.} and Okada, {Pamela J.} and Fleming, {Alesia H.} and Arms, {Joseph L.} and Thompson, {Amy D.} and Schmidt, {Suzanne M.} and Jeffrey Louie and Alfonzo, {Michael J.} and Monuteaux, {Michael C.} and Nigrovic, {Lise E.} and Alpern, {Elizabeth R.} and Fran Balamuth and Bradin, {Stuart A.} and Curtis, {Sarah J.} and Garro, {Aris C.} and Grether-Jones, {Kendra L} and Ishimine, {Paul T.} and Dina Kulik and Prashant Mahajan and Miller, {Aaron S.} and Mistry, {Rakesh D.} and Pruitt, {Christopher M.} and David Schnadower and Shah, {Samir S.} and Thomson, {Joanna E.} and Uspal, {Neil G.}",
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AU - Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus (HSV) Study Group

AU - Aronson, Paul L.

AU - Lyons, Todd W.

AU - Cruz, Andrea T.

AU - Freedman, Stephen B.

AU - Okada, Pamela J.

AU - Fleming, Alesia H.

AU - Arms, Joseph L.

AU - Thompson, Amy D.

AU - Schmidt, Suzanne M.

AU - Louie, Jeffrey

AU - Alfonzo, Michael J.

AU - Monuteaux, Michael C.

AU - Nigrovic, Lise E.

AU - Alpern, Elizabeth R.

AU - Balamuth, Fran

AU - Bradin, Stuart A.

AU - Curtis, Sarah J.

AU - Garro, Aris C.

AU - Grether-Jones, Kendra L

AU - Ishimine, Paul T.

AU - Kulik, Dina

AU - Mahajan, Prashant

AU - Miller, Aaron S.

AU - Mistry, Rakesh D.

AU - Pruitt, Christopher M.

AU - Schnadower, David

AU - Shah, Samir S.

AU - Thomson, Joanna E.

AU - Uspal, Neil G.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - 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.

AB - 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.

KW - enterovirus

KW - meningitis

KW - neonate

KW - young infant

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