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

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Abstract

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 <1 year 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.

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Abbreviations

CBC:

Complete blood count

CI:

Confidence interval

CRP:

C-reactive protein

ED:

Emergency department

hMPV:

Human metapneumovirus

ICD:

International Classification of Diseases

IQR:

Interquartile range

ICU:

Intensive care unit

LOS:

Hospital length of stay

LR:

Likelihood ratio

NGT:

Nasogastric tube

OR:

Odds ratio

PCR:

Polymerase chain reaction

RSV:

Respiratory syncytial virus

SD:

Standard deviation

SpO2 :

Pulse oxygen saturation

WBC:

White blood cell

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Acknowledgements

We would like to thank the Platform of Clinical Research of Children’s Hospital, University Hospitals of Geneva, Switzerland.

Funding

The completion of this project did not require background extern.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Pediatric Pulmonology Unit, Children’s Hospital, University Hospitals of Geneva, Rue Willy-Donzé 6, 1211, Geneva 14, Switzerland

    Fabiola Stollar & Constance Barazzone Argiroffo

  2. Pediatric Emergency Division, Children’s Hospital, University Hospitals of Geneva, Geneva, Switzerland

    Gabriel Alcoba & Alain Gervaix

Authors
  1. Fabiola Stollar
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  2. Gabriel Alcoba
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  3. Alain Gervaix
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  4. Constance Barazzone Argiroffo
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Corresponding author

Correspondence to Fabiola Stollar.

Additional information

Communicated by David Nadal

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Stollar, F., Alcoba, G., Gervaix, A. et al. Virologic testing in bronchiolitis: does it change management decisions and predict outcomes?. Eur J Pediatr 173, 1429–1435 (2014). https://doi.org/10.1007/s00431-014-2334-2

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  • DOI: https://doi.org/10.1007/s00431-014-2334-2

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