Impact of in-hospital enteroviral polymerase chain reaction testing on the clinical management of children with meningitis.

Abstract

BACKGROUND: Enteroviral meningitis is a common cause of meningitis in children which requires only supportive care. OBJECTIVE: To evaluate the impact of implementing an in-hospital enteroviral polymerase chain reaction (EVPCR) testing protocol on the clinical management of children with meningitis. DESIGN: Retrospective cohort study. POPULATION: Children <19 years old with meningitis. INTERVENTION: EVPCR testing differed by time period: send-out testing protocol from July 1, 2006-June 23, 2008 (pre-period) versus in-house testing protocol from June 24, 2008-June 30, 2010 (post-period). MEASUREMENTS: Test turnaround time, test utilization, length of stay, and duration of parenteral antibiotics. RESULTS: Of the 441 study patients, 216 (49%) presented during the post-period. Median age was 2.9 months (interquartile range, 1.5-96 months). Test turnaround time decreased with the in-house test (53 hours pre vs 13 hours post, P < 0.001), and test utilization increased (28% pre vs 62% post, P < 0.001). Among children with a positive EVPCR test, both length of stay (44 hours pre vs 28 hours post, P = 0.005) and duration of parenteral antibiotics (48 hours pre vs 36 hours post, P = 0.04) decreased in the post-period. No change in either of these outcomes was observed in children with meningitis and a negative EVPCR test. CONCLUSION: In-house EVPCR testing reduced test turnaround time, increased test utilization, and reduced both length of stay and duration of parenteral antibiotics for children with a positive result. Clinicians caring for children with meningitis should have access to in-hospital EVPCR testing.