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Multicenter Study
. 2017 Oct:189:169-174.e2.
doi: 10.1016/j.jpeds.2017.06.021. Epub 2017 Jul 10.

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

Paul L Aronson  1 , Todd W Lyons  2 , Andrea T Cruz  3 , Stephen B Freedman  4 , Pamela J Okada  5 , Alesia H Fleming  6 , Joseph L Arms  7 , Amy D Thompson  8 , Suzanne M Schmidt  9 , Jeffrey Louie  10 , Michael J Alfonzo  11 , Michael C Monuteaux  2 , Lise E Nigrovic  12 ; Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus (HSV) Study Group
Collaborators, Affiliations
Multicenter Study

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

Paul L Aronson et al. J Pediatr. 2017 Oct.

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.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study patients
Figure 2
Figure 2
Distribution of EV PCR testing and rates of positive EV PCR test results by hospital center
Figure 3 Online
Figure 3 Online
Rate of EV PCR testing vs rate of test positivity rate by hospital center
See this image and copyright information in PMC

Comment in

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