title: Clinical impact of RT-PCR for pediatric acute respiratory infections: a controlled clinical trial.
abstract: OBJECTIVE
  Real-time polymerase chain reaction (RT-PCR) testing is a quick sensitive method for detecting respiratory pathogens. We evaluated the diagnostic yield of RT-PCR assays and measured the effect of rapid reporting on patient care.
  
  
  METHODS
  In a controlled clinical trial, nasal wash specimens were obtained from patients <12 years of age with suspected acute respiratory infections. In addition to the standard hospital protocol, RT-PCR assays for 17 pathogens were performed. The RT-PCR results were communicated to the clinicians within 12 to 36 hours in the intervention group and after 4 weeks in the control group.
  
  
  RESULTS
  A total of 583 patients were included (mean age: 8.1 months [range: 0-107.5 months]): 298 in the intervention group and 285 in the control group. Eighty-two percent of nasal wash specimens tested positive for ≥1 pathogen. Respiratory syncytial virus was the most frequently encountered (55%) pathogen. There were no significant differences between the groups with respect to hospital admissions (intervention group: 223 admissions; control group: 211 admissions; P = .825), length of hospital stay (mean ± SD: 3.68 ± 2.68 days [intervention group] and 3.96 ± 2.67 days [control group]; P = .178), or duration of antibiotic use (mean ± SD: 6.52 ± 2.15 days [intervention group] and 6.97 ± 2.86 days [control group]; P = .490), when antibiotic treatment had been initiated.
  
  
  CONCLUSIONS
  RT-PCR testing has a high yield of viral diagnoses, but rapid communication does not lead to decreases in hospital admissions, shorter hospital stays, or less antibiotic use for children with acute respiratory infections.
authors: Department of Pediatrics, Reinier de Graaf Hospital, Delft, Netherlands. wishaupt@rdgg.nl
authors: Jérôme O
authors: JO
authors: Wishaupt
authors: Anne
authors: A
authors: Russcher
authors: Leo C
authors: LC
authors: Smeets
authors: Florens G A
authors: FG
authors: Versteegh
authors: Nico G
authors: NG
authors: Hartwig
mesh_terms: D000208:Acute Disease; D000998:Antiviral Agents / Q000627:therapeutic use; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands; D060888:Real-Time Polymerase Chain Reaction; D012016:Reference Values; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis* / Q000188:drug therapy; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification*; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000821:virology; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents