title: Impact of a Transition from Respiratory Virus Shell Vial to Multiplex PCR on Clinical Outcomes and Cost in Hospitalized Children.
abstract: While respiratory virus PCR panel (RVPP) is more expensive than shell vial (SV) cell culture, it has been shown to reduce unnecessary diagnostic procedures, decrease the inappropriate use of antimicrobials, and shorten the hospital length of stay (LOS). We therefore hypothesized that, for hospitalized children, RVPP would be associated with improved clinical outcomes but higher hospital charges than SV cell culture. We performed a retrospective cohort study of hospitalized children. Multivariate analysis was performed, andp-values were calculated. Respiratory virus testing was collected in a total of 1625 inpatient encounters, of which 156 were tested positive by RVPP (57.7%) and 112 were tested positive by SV (11.1%,p< 0.05). Excluding human rhinovirus (HRV) and human metapneumovirus (hMPV) from the analysis, patients with a positive test from SV had more comorbidities (p= 0.04) and higher mortality (p= 0.008). Patients with a positive test from RVPP had shorter LOS (p= 0.0503). Hospital charges for patients with a positive test from RVPP were lower, but not significantly so. When a multivariate analysis was performed, there were no statistically significant differences in comorbidities, mortality, LOS, or median hospital charges between those patients with a positive SV and those with a positive RVPP. Although testing with RVPP significantly increased the detection of respiratory viruses, clinical outcomes remained comparable to those tested with SV, however RVPP was found to not be associated with higher long-term hospital costs.
authors.affiliation: Division of Pediatric Infectious Diseases and Immunology, University of Minnesota Masonic Children's Hospital, Minneapolis, MN 55454, USA. irohtam@mlw.mw.|Malawi-Liverpool Wellcome Trust, Blantyre 3, Malawi. irohtam@mlw.mw.
authors.forename: Pui-Ying
authors.initials: PY
authors.lastname: Iroh Tam
authors.affiliation: Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN 55454, USA. zhangl@umn.edu.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN 55454, USA. zacohen@umn.edu.
authors.forename: Zohara
authors.initials: Z
authors.lastname: Cohen
keywords: cell culture; children; diagnostics; multiplex PCR; respiratory virus; shell vial