title: Virologic testing in bronchiolitis: does it change management decisions and predict outcomes?
abstract: The aim of this study was to evaluate the clinical, therapeutic, laboratory, and radiological differences between respiratory syncytial virus (RSV) and non-RSV bronchiolitis in order to assess if the prior knowledge of viral etiology changed management decisions and would be able to predict outcomes. Medical charts of children <1 year admitted to the emergency department with bronchiolitis during two RSV seasons (2010-2012) were reviewed. We analyzed 221 episodes of bronchiolitis. The percentage of exams performed (95 % confidence interval (CI) 0.74-2.52), abnormal laboratory and radiological findings (95 % CI 0.53-16.89) did not differ between groups. RSV bronchiolitis had a more severe clinical course. However, virologic testing for RSV had low specificity in identifying at-risk patients for hospitalization, longer hospital length of stay, and need of oxygen therapy and nasogastric tube (44, 40, 42, and 35 %, respectively), and while statistically significant, the positive likelihood ratios were only slightly greater than 1.
  
  
  CONCLUSIONS
  Although RSV bronchiolitis has a more severe clinical course, virologic testing does not help in management decisions, and at an individual level, as a performance test, it seems insufficient to precisely predict outcomes.
authors.affiliation: Pediatric Pulmonology Unit, Children's Hospital, University Hospitals of Geneva, Rue Willy-Donzé 6, 1211, Geneva 14, Switzerland, fabipediatria@hotmail.com.
authors.forename: Fabiola
authors.initials: F
authors.lastname: Stollar
authors.forename: Gabriel
authors.initials: G
authors.lastname: Alcoba
authors.forename: Alain
authors.initials: A
authors.lastname: Gervaix
authors.forename: Constance Barazzone
authors.initials: CB
authors.lastname: Argiroffo
mesh_terms: D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001990:Bronchiolitis, Viral / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D004359:Drug Therapy, Combination; D005188:False Negative Reactions; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D018113:Respiratory Syncytial Virus, Human / Q000302:isolation & purification*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013557:Switzerland
chemical_list: D000318:Adrenergic beta-Agonists; D000900:Anti-Bacterial Agents; D005938:Glucocorticoids