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Multicenter Study
. 2022 Jun 6;17(6):e0268532.
doi: 10.1371/journal.pone.0268532. eCollection 2022.

Risk factors for disease severity and increased medical resource utilization in respiratory syncytial virus (+) hospitalized children: A descriptive study conducted in four Belgian hospitals

Marijke Proesmans  1 , Annabel Rector  2 , Els Keyaerts  2 , Yannick Vandendijck  3 , Francois Vermeulen  1 , Kate Sauer  4 , Marijke Reynders  5 , Ann Verschelde  6 , Wim Laffut  7 , Kristien Garmyn  8 , Roman Fleischhackl  9 , Jacques Bollekens  3 , Gabriela Ispas  3
Affiliations
Multicenter Study

Risk factors for disease severity and increased medical resource utilization in respiratory syncytial virus (+) hospitalized children: A descriptive study conducted in four Belgian hospitals

Marijke Proesmans et al. PLoS One. .

Abstract

Background: We aimed to provide regional data on clinical symptoms, medical resource utilization (MRU), and risk factors for increased MRU in hospitalized respiratory syncytial virus (RSV)-infected Belgian pediatric population.

Methods: This prospective, multicenter study enrolled RSV (+) hospitalized children (aged ≤5y) during the 2013-2015 RSV seasons. RSV was diagnosed within 24h of hospitalization. Disease severity of RSV (+) patients was assessed until discharge or up to maximum six days using a Physical Examination Score (PES) and a derived score based on ability to feed, dyspnea and respiratory effort (PES3). MRU (concomitant medications, length of hospitalization [LOH], and oxygen supplementation) was evaluated. Kaplan-Meier survival analysis was performed to compare MRU by age and presence of risk factors for severe disease. Association between baseline covariates and MRU was analyzed using Cox regression models.

Results: In total, 75 children were included, Median (range) age was 4 (0-41) months, risk factors were present in 18.7%, and early hospitalization (≤3 days of symptom onset) was observed in 57.3% of patients. Cough (100%), feeding problems (82.2%), nasal discharge (87.8%), and rales and rhonchi (82.2%) were frequently observed. Median (range) LOH and oxygen supplementation was 5 (2-7) and 3 (1-7) days. Oxygen supplementation, bronchodilators, and antibiotics were administered to 58.7%, 64.0%, and 41.3% of the patients, respectively. Age <3 months and baseline total PES3 score were associated with probability and the duration of receiving oxygen supplementation. LOH was not associated with any covariate.

Conclusion: RSV is associated with high disease burden and MRU in hospitalized children. Oxygen supplementation but not length of hospitalization was associated with very young age and the PES3 score. These results warrant further assessment of the PES3 score as a predictor for the probability of receiving and length of oxygen supplementation in RSV hospitalized children.

Registration: NCT02133092.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: YV, RF, JB, and GI are employees of Janssen Pharmaceutica NV and may own stock in Johnson & Johnson. MP, AR, EK, FV, KS, MR, AV, WL, and KG have no conflict of interest.

Figures

Fig 1
Fig 1. PES item frequency over time as per item severity.
Relative frequency of each PES item is expressed as per item severity in all the patients. Item severity is scored from 0 to 3. Patients who were discharged were not considered in the following days’ calculation which could bias the improvement observed over time. Abbreviations: PES–Physical Examination Scoring.
Fig 2
Fig 2. PES item score over time as per underlying risk.
Mean ± SE PES item score is represented at each day of assessment for patients classified based on presence of absence of underlying risk. Patients who were discharged were not considered in the following days’ calculation which could bias the improvement observed over time. Abbreviations: PES–Physical Examination Scoring, SE–Standard Error.
Fig 3
Fig 3. Length of oxygen supplementation by age and underlying risk.
Kaplan-Meier curves represent the length of oxygen supplementation for (A) overall patients, (B) patients classified based on age, and (C) patients classified based on underlying risk.
See this image and copyright information in PMC

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