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Rapid PCR tests do not change management of acute respiratory infection in children

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – While real-time polymerase chain reaction (RT-PCR) testing is sensitive and rapid in diagnosing the cause of acute respiratory infection in children, it does not lead to significant changes in care. That’s according to the results of a Dutch study reported in the November issue of Pediatrics.

“The length of stay in the hospital and the duration of antibiotic treatment are not affected by rapid communication of the RT-PCR results,” conclude Dr. Jerome O. Wishaupt, with Reinier de Graaf Hospital in Delft, and colleagues.

The authors note that many hospitals have introduced RT-PCR assays for the detection of viral pathogens in children with acute respiratory infections, which has increased diagnostic costs but the effect on the costs of patient care are uncertain.

To investigate further, the team conducted a randomized trial involving 614 children younger than 12 years with suspected acute respiratory infections. Nasal wash specimens were obtained and RT-PCR assays were performed for 17 pathogens, in addition to the standard hospital diagnostic protocol.

“The RT-PCR results were communicated to the clinicians within 12 to 36 hours in the intervention group and after 4 weeks in the control group,” the investigators explain.

Ultimately 583 patients were included in their analysis. They found that there were no significant differences between the groups in terms of patients care.

Specifically, there were 223 hospital admissions in the intervention group versus 211 in the control group (p=0.825), and mean length of hospital stay was 3.68 days versus 3.96 days in the two arms (p=0.178), respectively.

Antibiotic treatment was started significantly more often in the intervention group (41.6%) than the control group (27.4%), according to the report. When antibiotics were initiated, duration of use was not significantly different, at 6.52 days in the intervention group and 6.97days in the control group (p=0.490).

Nonetheless, Dr. Wishaupt and colleagues do say that RT-PCR testing has advantages over other diagnostic methods, such as direct fluorescent assays, in terms of sensitivity and rapidity.

They conclude, “Logistic arguments and balancing of costs should help determine whether to adopt RT-PCR testing as the new standard for viral testing for children with ARIs (acute respiratory infections).”

Reference:

Clinical Impact of RT-PCR for Pediatrics Acute Respiratory Infections: A Controlled Clinical Trial

Pediatrics 2011;128.