152 - Viral Respiratory Testing Practices in Children with Positive Urinalysis Before, During, and After the COVID-19 Pandemic

Publication Number: 152.7015

Grace Truong, Baylor College of Medicine, Houston, TX, United States; Sowdhamini S. Wallace, Baylor College of Medicine, Houston, TX, United States; Kexin Guo, Baylor College of Medicine, Houston, TX, United States; Duc T. Nguyen, Baylor College of Medicine, Houston, TX, United States; Michael Dowlin, Baylor College of Medicine, Houston, TX, United States; Ila Singh, Baylor College of Medicine, Houston, TX, United States; Huay-Ying Lo, Texas Children's Hospital, Houston, TX, United States

Background: Respiratory viral panel (RVP) testing in young febrile children without localizing signs is a common but costly test that often does not change management or outcomes. Febrile children with positive urinalysis (UA) are an example where such testing may have limited utility. Little has been published on the utilization of RVPs and the impact of the COVID-19 pandemic on testing frequency.

Objective: To quantify changes in RVP utilization before, during, and after the COVID-19 pandemic in febrile children with positive UAs.

Design/Methods: We conducted a retrospective cohort study of febrile children (identified by ICD-10 code), aged ≤ 36 months with a positive UA (defined as + leukocytes and >5 WBCs/hpf, OR + nitrites), who presented to a quaternary children’s hospital emergency department from 3/2019 to 5/2024. Children were excluded if they had complex chronic conditions per the Feudtner criteria, required intensive care, respiratory or oxygen support, or had an ICD-10 code for sepsis. Structured demographic data and covariates were extracted from the electronic health record and supplemented with laboratory data from the hospital microbiology database. Time periods were defined as pre-pandemic – March 2019-February 2020, pandemic – March 2020-May 2023, and post-pandemic – June 2023-May 2024. The primary outcome was the proportion of children who received a nasal swab PCR or antigen viral testing within each time period. Testing was separated into panels that included COVID and flu testing, and those that did not. Differences in demographics and outcomes were determined by the chi-square test for categorical variables or Kruskal Wallis test for continuous variables. A p value of < 0.05 was considered statistically significant.

Results: There were 1,763 patients that fit eligibility criteria (Figure 1), 190 during pre-, 1193 during pandemic, and 380 during post-pandemic periods. Demographics between each period were similar except for insurance type (Table 1). The proportion of children who received an RVP was 36.8%, 67%, and 65.5% in the pre-, pandemic, and post-pandemic time periods, respectively. There was a statistically significant increase in viral testing during the pandemic and post-pandemic periods compared to the pre-pandemic period, even when excluding COVID/flu tests (p < 0.001) (Figure 2).

Conclusion(s): Our study demonstrates increased respiratory viral testing practices during and after the COVID pandemic, including non-COVID viral testing, in febrile children with positive UA. There could be opportunities for future quality improvement initiatives to decrease RVP overuse in this population.

Figure 1: Patients Meeting Inclusion and Exclusion Criteria
Figure 1: Patients Meeting Inclusion and Exclusion Criteria

Table 1: Demographic Characteristics of Patient Encounters Before, During, and After the COVID-19 Pandemic of Children with Fever and Positive Urinalysis
Table 1: Demographic Characteristics of Patient Encounters Before, During, and After the COVID-19 Pandemic of Children with Fever and Positive Urinalysis

Figure 2: Viral Test Counts Over Time by Quarter for Young Febrile Children with Positive Urinalysis during Pre-pandemic, Pandemic, and Post-pandemic Periods
Figure 2: Viral Test Counts Over Time by Quarter for Young Febrile Children with Positive Urinalysis during Pre-pandemic, Pandemic, and Post-pandemic Periods

Figure 1: Patients Meeting Inclusion and Exclusion Criteria
Figure 1: Patients Meeting Inclusion and Exclusion Criteria

Table 1: Demographic Characteristics of Patient Encounters Before, During, and After the COVID-19 Pandemic of Children with Fever and Positive Urinalysis
Table 1: Demographic Characteristics of Patient Encounters Before, During, and After the COVID-19 Pandemic of Children with Fever and Positive Urinalysis

Figure 2: Viral Test Counts Over Time by Quarter for Young Febrile Children with Positive Urinalysis during Pre-pandemic, Pandemic, and Post-pandemic Periods
Figure 2: Viral Test Counts Over Time by Quarter for Young Febrile Children with Positive Urinalysis during Pre-pandemic, Pandemic, and Post-pandemic Periods