Predictive value of the respiratory syncytial virus risk-scoring tool in the term infant in Canada.
BACKGROUND
Palivizumab prophylaxis against respiratory syncytial virus (RSV) infection has been widely adopted for high-risk infants during the RSV season, based on country-specific guidelines.


OBJECTIVE
To determine if a validated, risk-scoring tool (RST), can be applied to term, RSV-positive infants seen in the emergency room (ER) to predict need for hospitalization, in order to target prophylaxis cost effectively at a selected group of children.


METHODS
Retrospective, descriptive study.


METHODS
McMaster Children's Hospital in Hamilton, Ontario, Canada.


METHODS
A total of 72, consecutive, term, RSV-positive cases were identified retrospectively, from November through April during the 2006-2007 RSV season.


METHODS
A questionnaire/chart review was conducted on 68 of 72 cases, to determine risk categories based on the RST. Four, trained abstractors, extracted pertinent data from the medical records of RSV-positive patients. Means, standard deviations (SD), and percents were used to describe the study variables for hospitalized and ER patients discharged home. Chi-square tests were used to compare infants' risk factors to hospitalization. ANOVA was used for comparisons within and between risk groups and RST scores. A p-value of <0.05 was considered statistically significant.


RESULTS
The majority of infants scored in the low-risk category (n = 44), versus moderate (n = 16) or high risk (n = 8). Within the low-risk category, 27 (61%) of children were admitted to hospital compared to 17 (39%) who were treated in the ER and discharged home. The mean RST scores for those admitted to the pediatric intensive care unit/ward, the ward only, or those discharged home from the ER were 48.3 (n = 10), 41.0 (n = 36), and 36.5 (n = 22), respectively (p = 0.17). The mean number of risk factors for those discharged home versus hospitalized patients was 2.5 (1.3) and 2.97 (1.13), respectively (p = 0.15). Only two of eight cases in the high-risk group required intensive care.


CONCLUSIONS
Overall, the risk-scoring tool did not discriminate between low versus moderate- to high-risk RSV-positive term infants who require hospitalization which has cost implications, since universal prophylaxis of this cohort would be financially prohibitive. A larger study is necessary to establish risk factors that more accurately determine RSV hospitalization among term infants.
Paes
Bosco
B
Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada. paes@mcmaster.ca
Cole
Mara
M
Latchman
Andrew
A
Pinelli
Janet
J
D000465:Algorithms; D019072:Antibiotic Prophylaxis / Q000191:economics; D002170:Canada; D003362:Cost-Benefit Analysis; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control / Q000821:virology; D015997:Neonatal Screening / Q000191:economics / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D012107:Research Design; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control* / Q000821:virology; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification; D012189:Retrospective Studies; D012306:Risk; D018570:Risk Assessment; D047929:Term Birth / Q000097:blood / Q000502:physiology