title: Clinical evaluation of viral acute respiratory tract infections in children presenting to the emergency department of a tertiary referral hospital in the Netherlands.
abstract: BACKGROUND
  The relative incidence and clinical impact of individual respiratory viruses remains unclear among children presenting to the hospital emergency department with acute respiratory tract infection (ARTI).
  
  
  METHODS
  During two winter periods, respiratory virus real-time multiplex PCR results were evaluated from children (< 18 years) presenting to the emergency department of a tertiary referral hospital with ARTI that had been sampled within 48 hours of hospital presentation. In an attempt to identify virus-specific distinguishing clinical features, single virus infections were correlated with presenting signs and symptoms, clinical findings and outcomes using multivariate logistic regression.
  
  
  RESULTS
  In total, 274 children with ARTI were evaluated and most were aged < 3 years (236/274, 86%). PCR detected respiratory viruses in 224/274 (81.8%) children and included 162 (59%) single and 62 (23%) mixed virus infections. Respiratory syncytial virus (RSV) and human rhinovirus (HRV) single virus infections were common among children aged < 3 years, but proportional differences compared to older children were only significant for RSV (95% CI 1.3-15). Clinical differentiation between viral ARTIs was not possible due to common shared presenting signs and symptoms and the high frequency of mixed viral infections. We observed virus-associated outcome differences among children aged < 3 years. Oxygen treatment was associated with RSV (OR 3.6) and inversely correlated with FLU (OR 0.05). Treatment with steroids (OR 3.4) or bronchodilators (OR 3.4) was associated with HRV. Severe respiratory complications were associated with HRV (OR 3.5) and inversely correlated with RSV (OR 0.24).
  
  
  CONCLUSIONS
  Respiratory viruses are frequently detected in young children presenting to the hospital emergency department with ARTI and require PCR diagnosis since presenting signs and symptoms are not discriminant for a type of virus. RSV and HRV bear a high burden of morbidity in the pediatric clinical setting.
authors.affiliation: Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands. j.gooskens@lumc.nl.
authors.forename: Jairo
authors.initials: J
authors.lastname: Gooskens
authors.affiliation: Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands. vishnu@planet.nl.
authors.forename: Vishnu
authors.initials: V
authors.lastname: van der Ploeg
authors.affiliation: Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands. R.N.Sukhai@lumc.nl.
authors.forename: Ram N
authors.initials: RN
authors.lastname: Sukhai
authors.affiliation: Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands. A.C.T.M.Vossen@lumc.nl.
authors.forename: Ann C T M
authors.initials: AC
authors.lastname: Vossen
authors.affiliation: Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands. E.C.J.Claas@lumc.nl.
authors.forename: Eric C J
authors.initials: EC
authors.lastname: Claas
authors.affiliation: Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands. A.C.M.Kroes@lumc.nl.
authors.forename: Aloys C M
authors.initials: AC
authors.lastname: Kroes
mesh_terms: D001993:Bronchodilator Agents / Q000627:therapeutic use; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010102:Oxygen Inhalation Therapy; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy / Q000821:virology*; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use; D062606:Tertiary Care Centers
chemical_list: D001993:Bronchodilator Agents; D013256:Steroids