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Virologic testing in bronchiolitis: does it change management decisions and predict outcomes?

Stollar, Fabiola ; Alcoba, Gabriel ; Gervaix, Alain ; Argiroffo, Constance

In: European Journal of Pediatrics, 2014, vol. 173, no. 11, p. 1429-1435

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    Titre
    • Virologic testing in bronchiolitis: does it change management decisions and predict outcomes?
    Auteur
    • Stollar, Fabiola. Pediatric Pulmonology Unit, Children's Hospital, University Hospitals of Geneva, Rue Willy-Donzé 6, 1211, Geneva 14, Switzerland
    • Alcoba, Gabriel. Pediatric Emergency Division, Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
    • Gervaix, Alain. Pediatric Emergency Division, Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
    • Argiroffo, Constance. Pediatric Pulmonology Unit, Children's Hospital, University Hospitals of Geneva, Rue Willy-Donzé 6, 1211, Geneva 14, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • European Journal of Pediatrics, 2014, vol. 173, no. 11, p. 1429-1435. Springer Berlin Heidelberg
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:326578
    Summary
    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 <1year 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. Conclusion: 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.