Can respiratory syncytial virus etiology be diagnosed clinically? A hospital-based case-control study in children under two years of age
Cite this article as: Weigl, J.A.I., Puppe, W. & Schmitt, HJ. Eur J Epidemiol (2003) 18: 431. doi:10.1023/A:1024213400297 Abstract
An unmatched, hospital-based case–control study was performed, to determine, whether respiratory syncytial virus (RSV) etiology in hospitalized young children can be predicted clinically. Children under 2 years of age admitted with a lower respiratory tract infection in three hospitals in northern Germany were included (one tertiary and two secondary centers). Cases were children tested positive for RSV by multiplex RT-PCR. One control group consisted of children tested negative for RSV in the multiplex-RT-PCR and a second control group consisted of patients in whom no PCR was done. A weighted backward stepwise logistic regression model was applied for multivariate analysis. RSV-etiology could be predicted with a sensitivity of 72.8% and a specificity of 73.2%. Young age, disease entity – pneumonia or bronchiolitis, center, intercostal retractions, absence of an underlying condition, low level of C-reactive protein, short duration of symptoms (all on admission), prematurity and epidemiologic year were predictive; anatomical infiltrates and wheezing were not. Pathogen specific diagnosis is necessary for individual therapy, allocation in observational studies or treatment trials and for surveillance of airway infections in children, since the positive predictive value is too low for an accurate diagnosis and decision making. Multivariate techniques are effective tools in complex clinical research for deconfounding.
Case–control Clinical prediction Hospitalization Multivariate analysis Respiratory syncytial virus References
Parrott RH, Kim WH, Arrobio JO, et al. Epidemiology of respiratory syncytial virus infection in Washington, D.C. II. Infection and disease with respect to age, immunologic status, race and sex. Am J Epidemiol 1973; 98: 289–300.
Glezen WP, Paredes A, Allison JE, Taber LH, Frank AL. Risk of respiratory syncytial virus for infants from low-income families in relationship to age, sex, ethic group, and maternal antibody level. J Pediatr 1981; 98: 708–715.
Holberg CJ, Wright AL, Martinez FD, Ray CG, Taussig LM, Lebowitz MD. Risk factors for respiratory syncytial virus-associated lower respiratory illnesses in the first year of life. Am J Epidemiol 1991; 133: 1135–1151.
Weigl JAI, Puppe W, Schmitt HJ. Seasonality of Respiratory Syncytial Virus positive hospitalizations in children in Kiel, Germany over a 7 year period. Infection 2002; 30: 186–192.
Gröndahl B, Puppe W, Hoppe A, Kühne I, Weigl JAI, Schmitt H-J. Rapid identification of nine microorganisms causing acute respiratory tract infections by singletube multiplex reverse transcription-PCR: Feasibility study. J Clin Microbiol 1999; 37: 1–7.
Weigl JAI, Puppe W, Gröndahl B, Schmitt H-J. Epidemiological investigation of nine respiratory pathogens in hospitalized children in Germany using multiplex reverse-transcriptase polymerase chain reaction. Eur J Clin Mircrobiol Infect Dis 2000; 19: 336–343.
Weigl JAI, Puppe W, Schmitt H-J. Incidence of respiratory syncytial virus-associated hospitalizations in Germany. Eur J Clin Microbiol Infect Dis 2001; 20: 452–459.
Weigl JAI, Puppe W, Schmitt HJ. The incidence of influenza-associated hospitalizations in children in Germany. Epidemiol Infect 2002; 129: 525–534.
Isaacs D: Is bronchiolitis an obsolete term? Curr Opin Pediatr 1998; 10: 1–3.
Berner R, Schwoerer F, Schumacher RF, Meder M, Forster J. Community and nosocomially acquired respiratory syncytial virus in a German pediatric hospital from 1888 to 1999. Eur J Pediatr 2001; 160: 541–547.
Behrendt CE, Decker MD, Burch DJ, Watson PH for the International RSV Study Group. International variation in the management of infants hospitalized with respiratory syncytial virus. Eur J Pediatr 1998; 157: 215–220.
Brandenburg AH, Jeannet P-Y, v Steensel-Moll HA, et al. Local variability in respiratory syncytial virus disease severity. Arch Dis Child 1997; 77: 410–414.
Wang EEL, Law BJ, Boucher FD, et al. Pediatric investigators collaborative network on infections in Canada (PICNIC) study of admission and management variation in patients hospitalized with respiratory syncytial viral lower respiratory tract infection. J Pediatr 1996; 129: 390–395.
Cane PA, Pringle CR. Molecular epidemiology of human respiratory syncytial virus. Semin Virol 1995; 6: 371–378.
Graham NMH. Respiratory infections. In: Pless IB (ed.), The Epidemiology of Childhood Disorders. 1st ed. Oxford: Oxford University Press, 1994; 173-210.
Hall CB. Respiratory Syncytial Virus. In: Mandell GL, Bennett JE, Dolin R, (eds), Principles and Practice of Infectious Diseases. 5th ed. Vol 2. Philadelphia: Churchill Livingstone, 2000: 2084–2111.
Tammela OKT. First-year infections after initial hospitalization in low birth weight infants with and without bronchopulmonary dysplasia. Scand J Infect Dis 1992; 24: 515–524.
MacDonald NE, Hall CB, Suffin SC, Alexson C, Harris PJ, Manning JA. Respiratory syncytial viral infection in infants with congenital heart disease. N Engl J Med 1982; 307: 397–400.
Groothuis JR, Gutierrez KM, Lauer BA. Respiratory syncytial virus infection in children with bronchopulmunary dysplasia. Pediatrics 1988; 82: 199–203.
Kim HW, Arrobio JO, Brandt CD, et al. Epidemiology of respiratory syncytial virus infection in Washington, DC, I. Importance of the virus in different respiratory tract disease syndromes and temporal distribution of infection. Am J Epidemiol 1973; 98: 216–225.
Gardner PS. Respiratory syncytial virus infections. Postgraduate Med J 1973; 49: 788–791.
Carlsen K-H, Ørstavik I. Respiratory syncytial virus infections in Oslo 1972-1978. II. Clinical and laboratory studies. Acta Paediatr Scand 1980; 69: 723–729.
Campbell H, Byass P, Greenwood BM. Simple clinical signs for diagnosis of acute lower respiratory infections. Lancet 1988; 2: 742–743.
Hall CB, Hall WJ, Speers DM. Clinical and physiological manifestations in bronchiolitis and pneumonia. Am J Dis Child 1979; 133: 798–802.
McMillan JA, Tristram DA, Weiner LB, Higgins AP, Sandstrom C, Brandon R. Prediction of the duration of hospitalization in patients with respiratory syncytial virus infection: Use of clinical parameters. Pediatrics 1988; 81: 22–26.
Wang EEL, Law B, Stephens D. Pediatric investigators collaborative network on infections in Canada (PICNIC) prospective study of risk factors and outcomes in patients hospitalized with respiratory syncytial viral lower respiratory tract infection. J Pediatr 1995; 126: 212–219.
Brooks AM, McBride JT, McConnochie KM, Avirsam M, Long C, Hall CB. Predicting deterioration in previously healthy infants hospitalized with respiratory syncytial virus infection. Pediatrics 1999; 104: 463–467.
Heiskanen-Kosma T, Korppi M. Serum C-reactive protein cannot differentiate bacterial and viral aetiology of community-acquired pneumonia in children in primary healthcare settings. Scand J Infect Dis 2000; 32: 399–402.
Korppi M, Heiskanen-Kosma T, Leinonen M. White blood cells, C-reactive protein and erythrocyte sedimentation rate in pneumococcal pneumonia in children. Eur Respir J 1997; 10: 1125–1129.
Isaacs D. Problems in determining the etiology of community-acquired childhood pneumonia. Pediatr Infect Dis J 1989; 8: 143–148.
Fagan TJ. Nomogram for Bayes's theorem. N Engl J Med 1975; 293: 257.
Berkson J. Limitations of the application of fourfold table analysis to hospital data. Biomet Bull 1946; 2: 4753.
Feinstein AR, Walter SD, Horwitz RI. An analysis of Berkson's bias in case-control studies. J Chron Dis 1986; 39: 495–504.
Google Scholar Copyright information
© Kluwer Academic Publishers 2003