Impact of a diagnostic cerebrospinal fluid enterovirus polymerase chain reaction test on patient management.
BACKGROUND
Enterovirus (EV) infection, the most common cause of aseptic meningitis, can be rapidly diagnosed with an EV-specific reverse transcriptase polymerase chain reaction (EV-PCR) test. However, no studies have examined EV-PCR in a clinical context in which it is routinely used.


OBJECTIVE
To determine the impact of EV-PCR testing on diagnosis and clinical management of suspected aseptic meningitis cases.


METHODS
Retrospective review of electronic medical records from a 220-bed tertiary care pediatric medical center in San Diego, Calif.


METHODS
A total of 276 pediatric patients for whom a diagnostic EV-PCR test was performed during the calendar year 1998.


METHODS
Clinical parameters such as length of stay, medication use, and ancillary test use.


RESULTS
One hundred thirty-seven patients (49.6%) had a positive cerebrospinal fluid EV-PCR result. Enterovirus-positive patients with results available before hospital discharge (n=95) had significantly fewer ancillary tests performed (26% vs 72% with at least 1 test performed; P<.001), received intravenous antibiotics for less time (median, 2.0 vs 3.5 days; P<.001), and had shorter hospital stays (median, 42 vs 71.5 hours; P<.001) than EV-negative patients (n=92). A positive EV-PCR result was associated with more rapid hospital discharge (median EV-PCR-to-discharge time, 5.2 hours) compared with a negative result (median EV-PCR-to-discharge time, 27.4 hours; P<.001).


CONCLUSIONS
Our results suggest that a positive EV-PCR result may affect clinical decision making and can promote rapid discharge of patients, and that unnecessary diagnostic and therapeutic interventions can be reduced by use of EV-PCR testing. JAMA. 2000;283:2680-2685.
Ramers
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School of Medicine, University of California, 9500 Gilman Dr, #0927, La Jolla, CA 92093-0927, USA. mhsawyer@ucsd.edu
Billman
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Hartin
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Sawyer
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D002555:Cerebrospinal Fluid / Q000382:microbiology*; D002675:Child, Preschool; D004770:Enterovirus / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007964:Leukocytosis; D008297:Male; D008582:Meningitis, Aseptic / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000628:therapy; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D018709:Statistics, Nonparametric