Testing for Respiratory Viruses in Children

Respiratory virus detection and co‐infection in children and adults in a large Australian hospital in 2009–2015

“…Respiratory testing is an uncomfortable procedure that incurs expense. The rapid uptake of testing over this period highlights the need for testing behaviours to remain rational and cost‐effective . In the setting of prolonged viral shedding long after clinical resolution of disease, a positive result may even disadvantage patients and health‐care providers due to unnecessary periods of respiratory virus isolation in infected inpatients.…”

What the FLOQ? A quality improvement project to reduce unnecessary paediatric respiratory viral swabs in a peripheral metropolitan hospital

“…An email was sent to all paediatricians requesting feedback on rationalising FLOQ swabs to targeted patient groups only (Table ). The rational for this table was based on local physician agreement supported by published guidelines and shows concordance with a recently published paper advocating for rationalisation of patients appropriate for testing …”

“…We acknowledge there will always be cases where viral testing is appropriate to guide management, for example antibiotic stewardship in a febrile neonate with no source. However, the focus of our quality improvement project, backed by local physician agreement as well as current evidence, was to reduce testing in those patients in whom identifying the specific virus has no apparent impact on their clinical management in ED or as an inpatient and this has been a success.…”

“…Anecdotal evidence noted many of these patients were discharged directly from ED with the test result (dependant on when the sample was collected) hours or days later having questionable benefit to the already discharged patient (or ED physicians). A recently published paper ‘To Swab or Not to Swab’ suggests there is little or poor evidence for the current and historical reasoning behind respiratory viral testing and advocates for a rationalised approach.…”

American Thoracic Society 2019 Pediatric Core Curriculum

“…Diagnostic testing may be helpful for patients at highest risk for complications from viral infections, such as those with chronic medical conditions, or for children hospitalized when the cause of wheezing is unclear and identifying a specific virus may help exclude other diagnostic possibilities. Historically, the gold standard for diagnosis of respiratory viral infections was immunofluorescence assays and viral culture, but these have been replaced with multiplex polymerase chain reaction and nucleic acid amplification point of care testing, as these convey improved sensitivity and specificity as well as reduced resulting time …”