Trends in Respiratory Viral Testing in Pediatric Emergency Departments Following the COVID-19 Pandemic - 17/10/24
, Oluwakemi Badaki-Makun, MD, PhD b, Mohamed Eltorki, MBChB, MSc c, Pradip Chaudhari, MD d, Timothy T. Phamduy, DO e, Daniel Shapiro, MD, MPH f, Chris A. Rees, MD, MPH g, Kelly R. Bergmann, DO h, Mark I. Neuman, MD, MPH i, Douglas Lorenz, PhD j, Kenneth A. Michelson, MD, MPH a
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Abstract |
Study objective |
To evaluate for increases in the use and costs of respiratory viral testing in pediatric emergency departments (EDs) because of the COVID-19 pandemic.
Methods |
We performed a cross-sectional study using the pediatric health information system. Eligible subjects were children (90 days to 18 years) who were discharged from a pediatric ED and included in the pediatric health information system from October 2016 through March 2024. To evaluate for changes in the frequency and costs of respiratory viral testing, we performed an interrupted time series analysis across 3 study periods: prepandemic (October 1, 2016 to March 14, 2020), early pandemic (March 15, 2020 to December 31, 2023), and late pandemic (January 1, 2023 to March 31, 2024).
Results |
We included 15,261,939 encounters from 34 pediatric EDs over the 90-month study period. At least 1 viral respiratory test was performed for 460,826 of 7,311,177 prepandemic encounters (6.3%), 1,240,807 of 5,100,796 early pandemic encounters (24.3%), and 545,696 of 2,849,966 late pandemic encounters (19.1%). There was a positive prepandemic slope in viral testing (0.17% encounters/month; 95% CI 0.17 to 0.18). The early pandemic was associated with a shift change of 4.98% (95% CI 4.90 to 5.07) and a positive slope (0.54% encounters/month; 95% CI 0.54 to 0.55). The late pandemic period was associated with a negative shift (−17.80%; 95% CI −17.90 to −17.70) and a positive slope (0.42% encounters/month; 95% CI 0.41 to 0.42). The slope in testing costs increased from $5,000/month (95% CI $4,200 to $5,700) to $33,000/month (95% CI $32,000 to $34,000) during the early pandemic.
Conclusion |
Respiratory testing and associated costs increased during the COVID-19 pandemic and were sustained despite decreasing incidence of disease. These findings highlight a need for further efforts to clarify indications for viral testing in the ED and efforts to reduce low-value testing.
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| Please see page XX for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Benjamin T. Kerrey, MD, MS. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: SR and KAM participated in the conception of the design of the work, the analysis and interpretation of data, and the drafting of the manuscript. OB-M, ME, PC, TTP, DS, CAR, KRB, and MIN participated in the conception of the design of the work and reviewed the manuscript critically for important intellectual content. All authors provide approval of the final version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SR takes responsibility for the paper as a whole. |
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| Data sharing statement: The data sets generated and/or analyzed during the current study are not publicly available. Individuals who are interested in accessing the data may contact the Children’s Hospital Association. |
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| Authorship: All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. This study was supported by funding from the Stanley Manne Children’s Research Institute and by Pediatric Pandemic Network resources. The Pediatric Pandemic Network is supported by the Health Resources and Services Administration (HRSA) of the United States Department of Health and Human Services (HHS) as part of grant awards U1IMC43532 and U1IMC45814 with 0 percent financed with nongovernmental sources. The content presented here is that of the authors and does not necessarily represent the official views of, nor an endorsement by, HRSA. HHS, or the United State Government. For more information, visit HRSA.gov. |
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