Paul L Aronson1, Todd W Lyons2, Andrea T Cruz3, Stephen B Freedman4, Pamela J Okada5, Alesia H Fleming6, Joseph L Arms7, Amy D Thompson8, Suzanne M Schmidt9, Jeffrey Louie10, Michael J Alfonzo11, Michael C Monuteaux2, Lise E Nigrovic12. 1. Departments of Pediatrics and of Emergency Medicine, Yale School of Medicine, New Haven, CT. 2. Division of Emergency Medicine, Boston Children's Hospital, Boston, MA. 3. Sections of Pediatric Emergency Medicine & Infectious Diseases, Baylor College of Medicine, Houston, TX. 4. Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 5. Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX. 6. Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. 7. Department of Pediatrics, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN. 8. Departments of Pediatrics and of Emergency Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE. 9. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL. 10. Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN. 11. Departments of Pediatrics and of Emergency Medicine, Yale School of Medicine, New Haven, CT; Departments of Pediatrics and of Emergency Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY. 12. Division of Emergency Medicine, Boston Children's Hospital, Boston, MA. Electronic address: lise.nigrovic@childrens.harvard.edu.
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.
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.
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