689 - Is It Worth It? Assessing the Association of Respiratory Viral Testing on Pediatric Emergency Department Return Rates

Publication Number: 3666.689

Deborah L. Hammett, NemoursAlfred I. duPont Hospital for Children, Wilmington, DE, United States; Zhaoying Lu, Nemours Children's Hospital, Burke, VA, United States; Laura Santry, NemoursAlfred I. duPont Hospital for Children, Wilmington, DE, United States

Background: Up to 5% of patients seen in US pediatric emergency departments (PED) return within 72 hours, many of whom are low acuity status. Respiratory viral testing (RVT) for upper respiratory infection (URI) symptoms is controversial, but its use increased since the COVID-19 pandemic. This study investigates the effect of RVT at first PED visit with 72-hour return rates.

Objective: To determine if performing RVT or a positive RVT results in low acuity patients with URI symptoms at first PED visit effects 72-hour return rates. Secondary aims were to determine if performing RVT or positive RVT results impacts provider management at the second PED visit.

Design/Methods: We conducted a retrospective cohort study of patients ages 2 to 18 years presenting to two PEDs between January 2023-July 2024 with URI symptoms. Patients with an Emergency Service Index (ESI) of 3-5 who were discharged at first visit were included. The primary exposure was completion of RVT and primary outcome was 72-hour return rates. Sub-analyses were performed for type of RVT (limited vs. full panel) obtained and results status (positive vs. negative). Secondary outcomes included association of RVT at first visit with laboratory or imaging testing and antibiotic prescribing practices at second visit. We used chi-square tests and logistic regression to estimate odds ratios (ORs) with 95% confidence intervals (CIs). Confounding was addressed with inverse probability of treatment weighting via propensity scores, followed by weighted logistic regression. Adjusted ORs with 95% CIs and two-sided p-values were reported (α=0.05).

Results: A total of 20,114 patients were included for analysis, of which 8,024 (40%) completed RVT (Figure 1). The odds of returning to the PED in 72 hours were higher in patients who underwent RVT (adjusted OR 1.32 (1.08, 1.60) p=0.007). Patient 72-hour return rates did not differ based on type of RVT or RVT results (Table 1). The odds of prescribing antibiotics at a return PED visit decreased when RVT was positive at first visit (adjusted OR 0.53 (0.29, 0.96) p=0.037). Odds of laboratory or imaging studies at the return visit were not associated with completion of RVT at first encounter (Table 2).

Conclusion(s): RVT was associated with increased odds of low acuity patients with URI symptoms returning to the PED within 72-hours, but return rates did not differ based on type of RVT or RVT result. Positive RVT testing at first ED visit was associated with decrease odds of antibiotic prescriptions at return visit.

Figure 1
PAS Abstract Figure 1.pdfStudy Inclusion Flow Chart (RVT = respiratory viral testing, RVP= expanded respiratory viral panel PCR test, Quad = limited COVID, Flu-A, Flu-B, RSV PCR test)

Table 1
RVT PAS Abstract Table 1.pdfAssociation between (1) RVT (yes/no), (2) type of RVT (RVP/Quad) and (3) RVT result (positive/negative) and 72-hour Pediatric Emergency Department (PED) return rate. (RVT = respiratory viral testing, RVP= expanded respiratory viral panel PCR test, Quad = limited COVID, Flu-A, Flu-B, RSV PCR test)

Table 2
RVT PAS Abstract Table 2.pdfAssociation between RVT testing at first PED visit and (1) disposition (2) urine testing (3) Blood testing (4) imaging (5) IV hydration and (6) antibiotic use at 72-hour return visit. (RVT = respiratory viral testing, CMP= complete metabolic panel, BMP = basic metabolic panel, CBC = complete blood count, IV = intravenous)