Respiratory syncytial virus testing during bronchiolitis episodes of care in an integrated health care delivery system: A retrospective cohort study
Abstract Background: Bronchiolitis has the highest incidence rate of any lower respiratory infection among infants and children
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| Veröffentlicht in: | Clinical therapeutics 2010-12, Vol.32 (13), p.2220-2229 |
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| creator | Flaherman, Valerie, MD, MPH Li, Sherian, MS Ragins, Arona, MA Masaquel, Anthony, PhD, MPH Kipnis, Patricia, PhD Escobar, Gabriel J., MD |
| description | Abstract Background: Bronchiolitis has the highest incidence rate of any lower respiratory infection among infants and children |
| doi_str_mv | 10.1016/S0149-2918(10)80025-6 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_851749953</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0149291810800256</els_id><sourcerecordid>2734245271</sourcerecordid><originalsourceid>FETCH-LOGICAL-c477t-b922ebda872c539eeca9ca6d2d74f801498edbf721fbe09f2b5d1bbb36dd98673</originalsourceid><addsrcrecordid>eNqFkduKFDEQhhtR3HH1EZSAiHrRmqSP8UJZFk-wIHgA70I6qd7J2pO0qfRAv4cPbHp63IW98SYFqa_-OvxZ9pjRV4yy-vU3ykqRc8HaF4y-bCnlVV7fyTasbUTOWPnzbra5Rk6yB4hXlNJCVPx-dsJZweqqaDfZn6-Aow0q-jATnJ2eo1UD2dswIYmA0bpLYqawhC54p7fWDzZaJDBa9AaQ-J5oFYBYR5RLb4TLpAeGbEENcbsmDQx2D4ceGGH3hpyRADF4HEHHlCHab32IBONk5ofZvV4NCI-O8TT78eH99_NP-cWXj5_Pzy5yXTZNzDvBOXRGtQ3XVSEAtBJa1YabpuzbZfkWTNc3nPUdUNHzrjKs67qiNka0dVOcZs9X3TH431NaVu4sahgG5cBPKNuKNaUQVZHIp7fIKz8Fl4aTjBbpmIyxhapWSqfFMEAvx2B3KswJkotr8uCaXCxZvg6uyTrVPTmqT90OzHXVP5sS8OwIKNRq6INy2uINVzSionwZ4N3KQbra3kKQqC04DcaGdGdpvP3vKG9vKejBOpua_oIZ8GZriVzSVWTRYPSgUBd_AVIdzNk</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1033161113</pqid></control><display><type>article</type><title>Respiratory syncytial virus testing during bronchiolitis episodes of care in an integrated health care delivery system: A retrospective cohort study</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Flaherman, Valerie, MD, MPH ; Li, Sherian, MS ; Ragins, Arona, MA ; Masaquel, Anthony, PhD, MPH ; Kipnis, Patricia, PhD ; Escobar, Gabriel J., MD</creator><creatorcontrib>Flaherman, Valerie, MD, MPH ; Li, Sherian, MS ; Ragins, Arona, MA ; Masaquel, Anthony, PhD, MPH ; Kipnis, Patricia, PhD ; Escobar, Gabriel J., MD</creatorcontrib><description>Abstract Background: Bronchiolitis has the highest incidence rate of any lower respiratory infection among infants and children <2 years of age. Respiratory syncytial virus (RSV) is the most common etiology of bronchiolitis. The American Academy of Pediatrics does not recommend routine RSV testing for infants and children with bronchiolitis. The clinical predictors of RSV testing are unknown. Objectives: The aims of this study were to identify the rates and predictors of RSV testing during bronchiolitis and to explore the relationship between RSV test results and antibiotic treatment among infants and children aged <2 years. Methods: A retrospective study was conducted of 123,264 infants ≥32 weeks' gestational age (GA) who were born at 1 of 6 Northern California Kaiser Permanente Medical Center Program hospitals between 1996 and 2004. A bronchiolitis episode of care (EOC) was defined as ≥1 medical encounters with a bronchiolitis diagnosis code followed by 14 clear days without a bronchiolitis-related medical encounter. Descriptive statistics were used to report the frequency of tests, and logistic regression was used to assess the effect of hospitalization, chronologic age, gestational age, and season on the frequency of testing for RSV. Rapid direct fluorescent antibody testing was performed during the study. Results: The birth cohort was 51.2% male and 42.7% white, 20.8% Hispanic, 20.3% Asian, 8.4% African American, and 7.9% other. Of 23,748 bronchiolitis EOCs, 4969 (20.9%) had ≥1 test for RSV. Overall, 44.2% of all tests were positive for RSV. Physicians ordered RSV tests in 30.4% and 26.7% of bronchiolitis EOCs for infants born at 32 to 33 and 34 to 36 weeks' GA, respectively, compared with 17.9% of bronchiolitis EOCs for infants born at ≥41 weeks' GA. Bronchiolitis hospitalization, younger chronologic age, prematurity, and RSV season were associated with RSV testing in a multivariate model controlling for other variables, with an adjusted odds ratio (AOR) of 28.55 (95% CI, 24.99–36.62) for hospitalization status; AOR of 6.89 (95% CI, 5.19–9.15) for chronologic age <1 month; AOR of 0.85 (95% CI, 0.76–0.95) for GA >41 weeks; and AOR of 2.48 (95% CI, 2.24–2.74) for RSV season (December–March). Among hospitalized infants who were tested and had a diagnostic code suggesting treatment with antibiotics, use of antibiotics was significantly lower among those with a positive RSV test (63.4%) than those with a negative RSV test (75.5%) (χ2 test; P < 0.001). Conclusions: Approximately 20% of these children with bronchiolitis EOCs were tested for RSV; of those tested, about half were positive. In this integrated health care system, hospitalization with bronchiolitis, chronologic age, gestational age <37 weeks, neonatal oxygen exposure, and bronchiolitis EOC during the RSV season were the factors associated with testing for RSV.</description><identifier>ISSN: 0149-2918</identifier><identifier>EISSN: 1879-114X</identifier><identifier>DOI: 10.1016/S0149-2918(10)80025-6</identifier><identifier>PMID: 21316538</identifier><language>eng</language><publisher>Bridgewater, NJ: EM Inc USA</publisher><subject>Antibodies, Viral - blood ; Biological and medical sciences ; bronchiolitis ; Bronchiolitis, Viral - classification ; Bronchiolitis, Viral - epidemiology ; Bronchiolitis, Viral - virology ; California ; Child, Preschool ; Chronic obstructive pulmonary disease, asthma ; Delivery of Health Care, Integrated - methods ; Delivery of Health Care, Integrated - statistics & numerical data ; direct fluorescent antibody testing ; episodes of care ; Female ; Fluorescent Antibody Technique, Direct ; Follow-Up Studies ; Human viral diseases ; Humans ; Infant ; Infant, Newborn ; Infectious diseases ; Internal Medicine ; International Classification of Diseases ; Male ; Medical Education ; Medical sciences ; Multivariate Analysis ; Pharmacology. Drug treatments ; Pneumology ; Practice Patterns, Physicians' - statistics & numerical data ; Regression Analysis ; respiratory syncytial virus ; Respiratory Syncytial Virus, Human - isolation & purification ; Retrospective Studies ; Seasons ; Viral diseases ; Viral diseases of the respiratory system and ent viral diseases</subject><ispartof>Clinical therapeutics, 2010-12, Vol.32 (13), p.2220-2229</ispartof><rights>Elsevier HS Journals, Inc.</rights><rights>2010 Elsevier HS Journals, Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2010 Elsevier HS Journals, Inc. Published by EM Inc USA.. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c477t-b922ebda872c539eeca9ca6d2d74f801498edbf721fbe09f2b5d1bbb36dd98673</citedby><cites>FETCH-LOGICAL-c477t-b922ebda872c539eeca9ca6d2d74f801498edbf721fbe09f2b5d1bbb36dd98673</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0149291810800256$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23795023$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21316538$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Flaherman, Valerie, MD, MPH</creatorcontrib><creatorcontrib>Li, Sherian, MS</creatorcontrib><creatorcontrib>Ragins, Arona, MA</creatorcontrib><creatorcontrib>Masaquel, Anthony, PhD, MPH</creatorcontrib><creatorcontrib>Kipnis, Patricia, PhD</creatorcontrib><creatorcontrib>Escobar, Gabriel J., MD</creatorcontrib><title>Respiratory syncytial virus testing during bronchiolitis episodes of care in an integrated health care delivery system: A retrospective cohort study</title><title>Clinical therapeutics</title><addtitle>Clin Ther</addtitle><description>Abstract Background: Bronchiolitis has the highest incidence rate of any lower respiratory infection among infants and children <2 years of age. Respiratory syncytial virus (RSV) is the most common etiology of bronchiolitis. The American Academy of Pediatrics does not recommend routine RSV testing for infants and children with bronchiolitis. The clinical predictors of RSV testing are unknown. Objectives: The aims of this study were to identify the rates and predictors of RSV testing during bronchiolitis and to explore the relationship between RSV test results and antibiotic treatment among infants and children aged <2 years. Methods: A retrospective study was conducted of 123,264 infants ≥32 weeks' gestational age (GA) who were born at 1 of 6 Northern California Kaiser Permanente Medical Center Program hospitals between 1996 and 2004. A bronchiolitis episode of care (EOC) was defined as ≥1 medical encounters with a bronchiolitis diagnosis code followed by 14 clear days without a bronchiolitis-related medical encounter. Descriptive statistics were used to report the frequency of tests, and logistic regression was used to assess the effect of hospitalization, chronologic age, gestational age, and season on the frequency of testing for RSV. Rapid direct fluorescent antibody testing was performed during the study. Results: The birth cohort was 51.2% male and 42.7% white, 20.8% Hispanic, 20.3% Asian, 8.4% African American, and 7.9% other. Of 23,748 bronchiolitis EOCs, 4969 (20.9%) had ≥1 test for RSV. Overall, 44.2% of all tests were positive for RSV. Physicians ordered RSV tests in 30.4% and 26.7% of bronchiolitis EOCs for infants born at 32 to 33 and 34 to 36 weeks' GA, respectively, compared with 17.9% of bronchiolitis EOCs for infants born at ≥41 weeks' GA. Bronchiolitis hospitalization, younger chronologic age, prematurity, and RSV season were associated with RSV testing in a multivariate model controlling for other variables, with an adjusted odds ratio (AOR) of 28.55 (95% CI, 24.99–36.62) for hospitalization status; AOR of 6.89 (95% CI, 5.19–9.15) for chronologic age <1 month; AOR of 0.85 (95% CI, 0.76–0.95) for GA >41 weeks; and AOR of 2.48 (95% CI, 2.24–2.74) for RSV season (December–March). Among hospitalized infants who were tested and had a diagnostic code suggesting treatment with antibiotics, use of antibiotics was significantly lower among those with a positive RSV test (63.4%) than those with a negative RSV test (75.5%) (χ2 test; P < 0.001). Conclusions: Approximately 20% of these children with bronchiolitis EOCs were tested for RSV; of those tested, about half were positive. In this integrated health care system, hospitalization with bronchiolitis, chronologic age, gestational age <37 weeks, neonatal oxygen exposure, and bronchiolitis EOC during the RSV season were the factors associated with testing for RSV.</description><subject>Antibodies, Viral - blood</subject><subject>Biological and medical sciences</subject><subject>bronchiolitis</subject><subject>Bronchiolitis, Viral - classification</subject><subject>Bronchiolitis, Viral - epidemiology</subject><subject>Bronchiolitis, Viral - virology</subject><subject>California</subject><subject>Child, Preschool</subject><subject>Chronic obstructive pulmonary disease, asthma</subject><subject>Delivery of Health Care, Integrated - methods</subject><subject>Delivery of Health Care, Integrated - statistics & numerical data</subject><subject>direct fluorescent antibody testing</subject><subject>episodes of care</subject><subject>Female</subject><subject>Fluorescent Antibody Technique, Direct</subject><subject>Follow-Up Studies</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infectious diseases</subject><subject>Internal Medicine</subject><subject>International Classification of Diseases</subject><subject>Male</subject><subject>Medical Education</subject><subject>Medical sciences</subject><subject>Multivariate Analysis</subject><subject>Pharmacology. Drug treatments</subject><subject>Pneumology</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>Regression Analysis</subject><subject>respiratory syncytial virus</subject><subject>Respiratory Syncytial Virus, Human - isolation & purification</subject><subject>Retrospective Studies</subject><subject>Seasons</subject><subject>Viral diseases</subject><subject>Viral diseases of the respiratory system and ent viral diseases</subject><issn>0149-2918</issn><issn>1879-114X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkduKFDEQhhtR3HH1EZSAiHrRmqSP8UJZFk-wIHgA70I6qd7J2pO0qfRAv4cPbHp63IW98SYFqa_-OvxZ9pjRV4yy-vU3ykqRc8HaF4y-bCnlVV7fyTasbUTOWPnzbra5Rk6yB4hXlNJCVPx-dsJZweqqaDfZn6-Aow0q-jATnJ2eo1UD2dswIYmA0bpLYqawhC54p7fWDzZaJDBa9AaQ-J5oFYBYR5RLb4TLpAeGbEENcbsmDQx2D4ceGGH3hpyRADF4HEHHlCHab32IBONk5ofZvV4NCI-O8TT78eH99_NP-cWXj5_Pzy5yXTZNzDvBOXRGtQ3XVSEAtBJa1YabpuzbZfkWTNc3nPUdUNHzrjKs67qiNka0dVOcZs9X3TH431NaVu4sahgG5cBPKNuKNaUQVZHIp7fIKz8Fl4aTjBbpmIyxhapWSqfFMEAvx2B3KswJkotr8uCaXCxZvg6uyTrVPTmqT90OzHXVP5sS8OwIKNRq6INy2uINVzSionwZ4N3KQbra3kKQqC04DcaGdGdpvP3vKG9vKejBOpua_oIZ8GZriVzSVWTRYPSgUBd_AVIdzNk</recordid><startdate>20101201</startdate><enddate>20101201</enddate><creator>Flaherman, Valerie, MD, MPH</creator><creator>Li, Sherian, MS</creator><creator>Ragins, Arona, MA</creator><creator>Masaquel, Anthony, PhD, MPH</creator><creator>Kipnis, Patricia, PhD</creator><creator>Escobar, Gabriel J., MD</creator><general>EM Inc USA</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20101201</creationdate><title>Respiratory syncytial virus testing during bronchiolitis episodes of care in an integrated health care delivery system: A retrospective cohort study</title><author>Flaherman, Valerie, MD, MPH ; Li, Sherian, MS ; Ragins, Arona, MA ; Masaquel, Anthony, PhD, MPH ; Kipnis, Patricia, PhD ; Escobar, Gabriel J., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c477t-b922ebda872c539eeca9ca6d2d74f801498edbf721fbe09f2b5d1bbb36dd98673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Antibodies, Viral - blood</topic><topic>Biological and medical sciences</topic><topic>bronchiolitis</topic><topic>Bronchiolitis, Viral - classification</topic><topic>Bronchiolitis, Viral - epidemiology</topic><topic>Bronchiolitis, Viral - virology</topic><topic>California</topic><topic>Child, Preschool</topic><topic>Chronic obstructive pulmonary disease, asthma</topic><topic>Delivery of Health Care, Integrated - methods</topic><topic>Delivery of Health Care, Integrated - statistics & numerical data</topic><topic>direct fluorescent antibody testing</topic><topic>episodes of care</topic><topic>Female</topic><topic>Fluorescent Antibody Technique, Direct</topic><topic>Follow-Up Studies</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Infectious diseases</topic><topic>Internal Medicine</topic><topic>International Classification of Diseases</topic><topic>Male</topic><topic>Medical Education</topic><topic>Medical sciences</topic><topic>Multivariate Analysis</topic><topic>Pharmacology. Drug treatments</topic><topic>Pneumology</topic><topic>Practice Patterns, Physicians' - statistics & numerical data</topic><topic>Regression Analysis</topic><topic>respiratory syncytial virus</topic><topic>Respiratory Syncytial Virus, Human - isolation & purification</topic><topic>Retrospective Studies</topic><topic>Seasons</topic><topic>Viral diseases</topic><topic>Viral diseases of the respiratory system and ent viral diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Flaherman, Valerie, MD, MPH</creatorcontrib><creatorcontrib>Li, Sherian, MS</creatorcontrib><creatorcontrib>Ragins, Arona, MA</creatorcontrib><creatorcontrib>Masaquel, Anthony, PhD, MPH</creatorcontrib><creatorcontrib>Kipnis, Patricia, PhD</creatorcontrib><creatorcontrib>Escobar, Gabriel J., MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Flaherman, Valerie, MD, MPH</au><au>Li, Sherian, MS</au><au>Ragins, Arona, MA</au><au>Masaquel, Anthony, PhD, MPH</au><au>Kipnis, Patricia, PhD</au><au>Escobar, Gabriel J., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Respiratory syncytial virus testing during bronchiolitis episodes of care in an integrated health care delivery system: A retrospective cohort study</atitle><jtitle>Clinical therapeutics</jtitle><addtitle>Clin Ther</addtitle><date>2010-12-01</date><risdate>2010</risdate><volume>32</volume><issue>13</issue><spage>2220</spage><epage>2229</epage><pages>2220-2229</pages><issn>0149-2918</issn><eissn>1879-114X</eissn><abstract>Abstract Background: Bronchiolitis has the highest incidence rate of any lower respiratory infection among infants and children <2 years of age. Respiratory syncytial virus (RSV) is the most common etiology of bronchiolitis. The American Academy of Pediatrics does not recommend routine RSV testing for infants and children with bronchiolitis. The clinical predictors of RSV testing are unknown. Objectives: The aims of this study were to identify the rates and predictors of RSV testing during bronchiolitis and to explore the relationship between RSV test results and antibiotic treatment among infants and children aged <2 years. Methods: A retrospective study was conducted of 123,264 infants ≥32 weeks' gestational age (GA) who were born at 1 of 6 Northern California Kaiser Permanente Medical Center Program hospitals between 1996 and 2004. A bronchiolitis episode of care (EOC) was defined as ≥1 medical encounters with a bronchiolitis diagnosis code followed by 14 clear days without a bronchiolitis-related medical encounter. Descriptive statistics were used to report the frequency of tests, and logistic regression was used to assess the effect of hospitalization, chronologic age, gestational age, and season on the frequency of testing for RSV. Rapid direct fluorescent antibody testing was performed during the study. Results: The birth cohort was 51.2% male and 42.7% white, 20.8% Hispanic, 20.3% Asian, 8.4% African American, and 7.9% other. Of 23,748 bronchiolitis EOCs, 4969 (20.9%) had ≥1 test for RSV. Overall, 44.2% of all tests were positive for RSV. Physicians ordered RSV tests in 30.4% and 26.7% of bronchiolitis EOCs for infants born at 32 to 33 and 34 to 36 weeks' GA, respectively, compared with 17.9% of bronchiolitis EOCs for infants born at ≥41 weeks' GA. Bronchiolitis hospitalization, younger chronologic age, prematurity, and RSV season were associated with RSV testing in a multivariate model controlling for other variables, with an adjusted odds ratio (AOR) of 28.55 (95% CI, 24.99–36.62) for hospitalization status; AOR of 6.89 (95% CI, 5.19–9.15) for chronologic age <1 month; AOR of 0.85 (95% CI, 0.76–0.95) for GA >41 weeks; and AOR of 2.48 (95% CI, 2.24–2.74) for RSV season (December–March). Among hospitalized infants who were tested and had a diagnostic code suggesting treatment with antibiotics, use of antibiotics was significantly lower among those with a positive RSV test (63.4%) than those with a negative RSV test (75.5%) (χ2 test; P < 0.001). Conclusions: Approximately 20% of these children with bronchiolitis EOCs were tested for RSV; of those tested, about half were positive. In this integrated health care system, hospitalization with bronchiolitis, chronologic age, gestational age <37 weeks, neonatal oxygen exposure, and bronchiolitis EOC during the RSV season were the factors associated with testing for RSV.</abstract><cop>Bridgewater, NJ</cop><pub>EM Inc USA</pub><pmid>21316538</pmid><doi>10.1016/S0149-2918(10)80025-6</doi><tpages>10</tpages></addata></record> |
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| subjects | Antibodies, Viral - blood Biological and medical sciences bronchiolitis Bronchiolitis, Viral - classification Bronchiolitis, Viral - epidemiology Bronchiolitis, Viral - virology California Child, Preschool Chronic obstructive pulmonary disease, asthma Delivery of Health Care, Integrated - methods Delivery of Health Care, Integrated - statistics & numerical data direct fluorescent antibody testing episodes of care Female Fluorescent Antibody Technique, Direct Follow-Up Studies Human viral diseases Humans Infant Infant, Newborn Infectious diseases Internal Medicine International Classification of Diseases Male Medical Education Medical sciences Multivariate Analysis Pharmacology. Drug treatments Pneumology Practice Patterns, Physicians' - statistics & numerical data Regression Analysis respiratory syncytial virus Respiratory Syncytial Virus, Human - isolation & purification Retrospective Studies Seasons Viral diseases Viral diseases of the respiratory system and ent viral diseases |
| title | Respiratory syncytial virus testing during bronchiolitis episodes of care in an integrated health care delivery system: A retrospective cohort study |
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