title: Impact of in-hospital enteroviral polymerase chain reaction testing on the clinical management of children with meningitis.
abstract: BACKGROUND
  Enteroviral meningitis is a common cause of meningitis in children which requires only supportive care.
  
  
  OBJECTIVE
  To evaluate the impact of implementing an in-hospital enteroviral polymerase chain reaction (EVPCR) testing protocol on the clinical management of children with meningitis.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Children <19 years old with meningitis.
  
  
  METHODS
  EVPCR testing differed by time period: send-out testing protocol from July 1, 2006-June 23, 2008 (pre-period) versus in-house testing protocol from June 24, 2008-June 30, 2010 (post-period).
  
  
  METHODS
  Test turnaround time, test utilization, length of stay, and duration of parenteral antibiotics.
  
  
  RESULTS
  Of the 441 study patients, 216 (49%) presented during the post-period. Median age was 2.9 months (interquartile range, 1.5-96 months). Test turnaround time decreased with the in-house test (53 hours pre vs 13 hours post, P < 0.001), and test utilization increased (28% pre vs 62% post, P < 0.001). Among children with a positive EVPCR test, both length of stay (44 hours pre vs 28 hours post, P = 0.005) and duration of parenteral antibiotics (48 hours pre vs 36 hours post, P = 0.04) decreased in the post-period. No change in either of these outcomes was observed in children with meningitis and a negative EVPCR test.
  
  
  CONCLUSIONS
  In-house EVPCR testing reduced test turnaround time, increased test utilization, and reduced both length of stay and duration of parenteral antibiotics for children with a positive result. Clinicians caring for children with meningitis should have access to in-hospital EVPCR testing.
authors.affiliation: Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. Todd.Lyons@childrens.harvard.edu
authors.forename: Todd W
authors.initials: TW
authors.lastname: Lyons
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: McAdam
authors.forename: Keri A
authors.initials: KA
authors.lastname: Cohn
authors.forename: Michael C
authors.initials: MC
authors.lastname: Monuteaux
authors.forename: Lise E
authors.initials: LE
authors.lastname: Nigrovic
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D004770:Enterovirus / Q000302:isolation & purification; D004769:Enterovirus Infections / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D008587:Meningitis, Viral / Q000175:diagnosis* / Q000188:drug therapy; D010372:Pediatrics; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D013223:Statistics as Topic; D013995:Time
chemical_list: D000900:Anti-Bacterial Agents