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Academic Emergency Medicine Volume 10, Number 5 440,
© 2003 Society for Academic Emergency Medicine
 

Clinical Predictors of Respiratory Syncytial Virus (RSV) in Children

Magdy W Attia and Marla J Friedman

Alfred I. duPont Hospital for Children: Wilmington, DE

ABSTRACT

Background: RSV is a common cause of respiratory illness with a significant morbidity to the pediatric population. It is difficult to distinguish RSV from other respiratory illnesses clinically. Several rapid diagnostic tests are available to aid in the diagnosis; however, they have limited sensitivity and specificity. A prediction model that identifies patients likely to have RSV may enhance the predictive values of these tests. Objective: To identify clinical features that are most predictive of RSV infection in children. Methods: Patients who presented to a pediatric emergency department with a respiratory illness in January and February of 2002 and who were tested for RSV infection based on a clinical decision by the ED physician were enrolled. Each patient received a nasal wash for rapid RSV testing. Samples with negative rapid test were further processed for viral culture. Demographic information and clinical features were collected prospectively using a standardized form. Stepwise logistic regression analysis of 20 clinical variables was performed to determine clinical features independently predictive of RSV. Results: 197 patients were enrolled. Median age and range was 5 and 31 months respectively. 57% were males. There were 126 (64%) patients positive for RSV by either rapid test or viral culture. There was no significant difference between the RSV group and the remainder of patients in age or gender. In the regression analysis 33 cases (17%) were removed due to incomplete data points. Cough (p < 0.0001), wheezing (p = 0.002), and retractions (p = 0.007) were independently associated with RSV infection. Hosmer-Lemeshow goodness of fit test ² was 4.0; p = 0.9. The model of these 3 clinical features has a sensitivity of 80% (95% CI:71,87); a specificity of 69% (95% CI:53,79), and likelihood ratio of 2.5 (95%CI:1.8,3.7). Conclusion: Clinical predictors of RSV in children are identified. If validated, this model may enhance the predictive abilities of available laboratory tests.

Copyright © 2003 by the Society for Academic Emergency Medicine.

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