Impact of respiratory viral panel testing on length of stay in pediatric cancer patients admitted with fever and neutropenia.
Impact of respiratory viral panel testing on length of stay in pediatric cancer patients admitted with fever and neutropenia.
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DOI：
10.1002/pbc.28570
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发表时间：
2020-11
影响因子：
3.2
通讯作者：
Miller TP
中科院分区：
文献类型：
--
作者：
Shinn K;Wetzel M;DeGroote NP;Keller F;Briones M;Felker J;Castellino S;Miller TP
聚合酶链反应（PCR）呼吸道病毒检测（RVP）常用于评估伴发热性中性粒细胞减少症（FN）的儿童癌症患者，但与不良结局的相关性尚未得到很好的表征。确定了2013年1月至2016年6月期间因FN而入住亚特兰大儿童保健中心的所有0-21岁癌症儿童的回顾性队列。患者的人口统计学和临床变量，如年龄，RVP结果，住院时间（LOS）和死亡进行了提取。采用Wilcoxon秩和、卡方检验或Fisher精确检验，调整年龄、性别、菌血症和诊断，比较RVP检测和阳性与LOS、最高体温（Tmax）、低血压和ICU入院之间的关系。确定的404例患者共有787例FN入院。38%的住院患者发送了RVP，59%的患者为阳性。发送RVP的患者更年轻（中位数5.5 vs. 8.0岁，p<0.0001），Tmax更高（39.2° vs. 39.1°，p=0.016）。发现的最常见病毒是鼻病毒/肠道病毒（61%）。基于RVP阳性的最高体温或最低血压无显著差异。入住ICU的患者更有可能发送RVP（OR=3.19，p<0.002），然而，RVP检测或RVP阳性均与LOS增加或死亡显著相关。在9.1%的患者中确定了菌血症和呼吸道病毒的合并感染。这些数据提出了发送潜在昂贵的RVP测试的效用问题，因为发热性中性粒细胞减少症期间RVP阳性不影响LOS、低血压程度或ICU入院。
Polymerase chain reaction (PCR) respiratory viral panel (RVP) testing is often used in evaluation of pediatric cancer patients with febrile neutropenia (FN), but correlation with adverse outcomes has not been well characterized. A retrospective cohort of all children ages 0–21 with cancer admitted to Children’s Healthcare of Atlanta for FN from January 2013 to June 2016 was identified. Patient demographic and clinical variables such as age, RVP results, length of stay (LOS), and deaths were abstracted. Relationship between RVP testing and positivity and LOS, highest temperature (Tmax), hypotension and ICU admission were compared using Wilcoxon rank sums, Chi-square, or Fisher’s exact tests adjusting for age, sex, bacteremia, and diagnosis. The 404 patients identified had 787 total FN admissions. RVPs were sent in 38% of admissions and were positive in 59%. Patients with RVPs sent were younger (median 5.5 vs. 8.0 years, p<0.0001) with higher Tmax (39.2° vs. 39.1°, p=0.016). The most common virus identified was Rhinovirus/Enterovirus (61%). There were no significant differences in highest temperature or lowest blood pressure based on RVP positivity. Patients admitted to the ICU were more likely to have RVPs sent (OR=3.19, p<0.002), however neither having RVP testing nor RVP positivity were significantly associated with increased LOS or death. Coinfection with bacteremia and a respiratory virus was identified in 9.1% of patients. These data raise the question of the utility of sending potentially costly RVP testing as RVP positivity during febrile neutropenia does not impact LOS, degree of hypotension, or ICU admission.
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DOI：
10.1097/01.mph.0000212996.94929.0b
发表时间：
2006-10-01
影响因子：
1.2
作者：
Porto Rondinelli, Patricia Imperatriz;Braga Ribeiro, Karina de Cassia;de Camargo, Beatriz
通讯作者：
de Camargo, Beatriz
影响因子：
3.2
作者：
Esbenshade, Adam J.;Di Pentima, M. Cecilia;Friedman, Debra L.
通讯作者：
Friedman, Debra L.
影响因子：
8
作者：
El Saleeby, Chadi M.;Somes, Grant W.;Gaur, Aditya H.
通讯作者：
Gaur, Aditya H.
影响因子：
6.2
作者：
Hakim, Hana;Dallas, Ronald;Jeha, Sima
通讯作者：
Jeha, Sima
影响因子：
9.4
作者：
Babady, N. Esther;Mead, Peter;Kamboj, Mini
通讯作者：
Kamboj, Mini