Impact of Enteroviral Polymerase Chain Reaction Testing on Length of Stay for Infants 60 Days Old or Younger

Paul L. Aronson, Todd W. Lyons, Andrea T. Cruz, Stephen B. Freedman, Pamela J. Okada, Alesia H. Fleming, Joseph L. Arms, Amy D. Thompson, Suzanne M. Schmidt, Jeffrey Louie, Michael J. Alfonzo, Michael C. Monuteaux, Lise E. Nigrovic

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective: To determine the impact of a cerebrospinal fluid enterovirus polymerase chain reaction (PCR) test performance on hospital length of stay (LOS) in a large multicenter cohort of infants undergoing evaluation for central nervous system infection. Study design: We performed a planned secondary analysis of a retrospective cohort of hospitalized infants ≤60 days of age who had a cerebrospinal fluid culture obtained at 1 of 18 participating centers (2005-2013). After adjustment for patient age and study year as well as clustering by hospital center, we compared LOS for infants who had an enterovirus PCR test performed vs not performed and among those tested, for infants with a positive vs negative test result. Results: Of 19 953 hospitalized infants, 4444 (22.3%) had an enterovirus PCR test performed and 945 (21.3% of tested infants) had positive test results. Hospital LOS was similar for infants who had an enterovirus PCR test performed compared with infants who did not (incident rate ratio 0.98 hours; 95% CI 0.89-1.06). However, infants PCR positive for enterovirus had a 38% shorter LOS than infants PCR negative for enterovirus (incident rate ratio 0.62 hours; 95% CI 0.57-0.68). No infant with a positive enterovirus PCR test had bacterial meningitis (0%; 95% CI 0-0.4). Conclusions: Although enterovirus PCR testing was not associated with a reduction in LOS, infants with a positive enterovirus PCR test had a one-third shorter LOS compared with infants with a negative enterovirus PCR test. Focused enterovirus PCR test use could increase the impact on LOS for infants undergoing cerebrospinal fluid evaluation.

Original languageEnglish (US)
JournalJournal of Pediatrics
DOIs
StateAccepted/In press - 2017

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Enterovirus
Length of Stay
Polymerase Chain Reaction
Cerebrospinal Fluid
Central Nervous System Infections
Bacterial Meningitides
Cluster Analysis

Keywords

  • Enterovirus
  • Meningitis
  • Neonate
  • Young infant

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Impact of Enteroviral Polymerase Chain Reaction Testing on Length of Stay for Infants 60 Days Old or Younger. / Aronson, Paul L.; Lyons, Todd W.; Cruz, Andrea T.; Freedman, Stephen B.; Okada, Pamela J.; Fleming, Alesia H.; Arms, Joseph L.; Thompson, Amy D.; Schmidt, Suzanne M.; Louie, Jeffrey; Alfonzo, Michael J.; Monuteaux, Michael C.; Nigrovic, Lise E.

In: Journal of Pediatrics, 2017.

Research output: Contribution to journalArticle

Aronson, PL, Lyons, TW, Cruz, AT, Freedman, SB, Okada, PJ, Fleming, AH, Arms, JL, Thompson, AD, Schmidt, SM, Louie, J, Alfonzo, MJ, Monuteaux, MC & Nigrovic, LE 2017, 'Impact of Enteroviral Polymerase Chain Reaction Testing on Length of Stay for Infants 60 Days Old or Younger', Journal of Pediatrics. https://doi.org/10.1016/j.jpeds.2017.06.021
Aronson, Paul L. ; Lyons, Todd W. ; Cruz, Andrea T. ; Freedman, Stephen B. ; Okada, Pamela J. ; Fleming, Alesia H. ; Arms, Joseph L. ; Thompson, Amy D. ; Schmidt, Suzanne M. ; Louie, Jeffrey ; Alfonzo, Michael J. ; Monuteaux, Michael C. ; Nigrovic, Lise E. / Impact of Enteroviral Polymerase Chain Reaction Testing on Length of Stay for Infants 60 Days Old or Younger. In: Journal of Pediatrics. 2017.
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abstract = "Objective: To determine the impact of a cerebrospinal fluid enterovirus polymerase chain reaction (PCR) test performance on hospital length of stay (LOS) in a large multicenter cohort of infants undergoing evaluation for central nervous system infection. Study design: We performed a planned secondary analysis of a retrospective cohort of hospitalized infants ≤60 days of age who had a cerebrospinal fluid culture obtained at 1 of 18 participating centers (2005-2013). After adjustment for patient age and study year as well as clustering by hospital center, we compared LOS for infants who had an enterovirus PCR test performed vs not performed and among those tested, for infants with a positive vs negative test result. Results: Of 19 953 hospitalized infants, 4444 (22.3{\%}) had an enterovirus PCR test performed and 945 (21.3{\%} of tested infants) had positive test results. Hospital LOS was similar for infants who had an enterovirus PCR test performed compared with infants who did not (incident rate ratio 0.98 hours; 95{\%} CI 0.89-1.06). However, infants PCR positive for enterovirus had a 38{\%} shorter LOS than infants PCR negative for enterovirus (incident rate ratio 0.62 hours; 95{\%} CI 0.57-0.68). No infant with a positive enterovirus PCR test had bacterial meningitis (0{\%}; 95{\%} CI 0-0.4). Conclusions: Although enterovirus PCR testing was not associated with a reduction in LOS, infants with a positive enterovirus PCR test had a one-third shorter LOS compared with infants with a negative enterovirus PCR test. Focused enterovirus PCR test use could increase the impact on LOS for infants undergoing cerebrospinal fluid evaluation.",
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T1 - Impact of Enteroviral Polymerase Chain Reaction Testing on Length of Stay for Infants 60 Days Old or Younger

AU - Aronson, Paul L.

AU - Lyons, Todd W.

AU - Cruz, Andrea T.

AU - Freedman, Stephen B.

AU - Okada, Pamela J.

AU - Fleming, Alesia H.

AU - Arms, Joseph L.

AU - Thompson, Amy D.

AU - Schmidt, Suzanne M.

AU - Louie, Jeffrey

AU - Alfonzo, Michael J.

AU - Monuteaux, Michael C.

AU - Nigrovic, Lise E.

PY - 2017

Y1 - 2017

N2 - Objective: To determine the impact of a cerebrospinal fluid enterovirus polymerase chain reaction (PCR) test performance on hospital length of stay (LOS) in a large multicenter cohort of infants undergoing evaluation for central nervous system infection. Study design: We performed a planned secondary analysis of a retrospective cohort of hospitalized infants ≤60 days of age who had a cerebrospinal fluid culture obtained at 1 of 18 participating centers (2005-2013). After adjustment for patient age and study year as well as clustering by hospital center, we compared LOS for infants who had an enterovirus PCR test performed vs not performed and among those tested, for infants with a positive vs negative test result. Results: Of 19 953 hospitalized infants, 4444 (22.3%) had an enterovirus PCR test performed and 945 (21.3% of tested infants) had positive test results. Hospital LOS was similar for infants who had an enterovirus PCR test performed compared with infants who did not (incident rate ratio 0.98 hours; 95% CI 0.89-1.06). However, infants PCR positive for enterovirus had a 38% shorter LOS than infants PCR negative for enterovirus (incident rate ratio 0.62 hours; 95% CI 0.57-0.68). No infant with a positive enterovirus PCR test had bacterial meningitis (0%; 95% CI 0-0.4). Conclusions: Although enterovirus PCR testing was not associated with a reduction in LOS, infants with a positive enterovirus PCR test had a one-third shorter LOS compared with infants with a negative enterovirus PCR test. Focused enterovirus PCR test use could increase the impact on LOS for infants undergoing cerebrospinal fluid evaluation.

AB - Objective: To determine the impact of a cerebrospinal fluid enterovirus polymerase chain reaction (PCR) test performance on hospital length of stay (LOS) in a large multicenter cohort of infants undergoing evaluation for central nervous system infection. Study design: We performed a planned secondary analysis of a retrospective cohort of hospitalized infants ≤60 days of age who had a cerebrospinal fluid culture obtained at 1 of 18 participating centers (2005-2013). After adjustment for patient age and study year as well as clustering by hospital center, we compared LOS for infants who had an enterovirus PCR test performed vs not performed and among those tested, for infants with a positive vs negative test result. Results: Of 19 953 hospitalized infants, 4444 (22.3%) had an enterovirus PCR test performed and 945 (21.3% of tested infants) had positive test results. Hospital LOS was similar for infants who had an enterovirus PCR test performed compared with infants who did not (incident rate ratio 0.98 hours; 95% CI 0.89-1.06). However, infants PCR positive for enterovirus had a 38% shorter LOS than infants PCR negative for enterovirus (incident rate ratio 0.62 hours; 95% CI 0.57-0.68). No infant with a positive enterovirus PCR test had bacterial meningitis (0%; 95% CI 0-0.4). Conclusions: Although enterovirus PCR testing was not associated with a reduction in LOS, infants with a positive enterovirus PCR test had a one-third shorter LOS compared with infants with a negative enterovirus PCR test. Focused enterovirus PCR test use could increase the impact on LOS for infants undergoing cerebrospinal fluid evaluation.

KW - Enterovirus

KW - Meningitis

KW - Neonate

KW - Young infant

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