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http://www.aemj.org/cgi/content/abstract/10/5/440-a
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Academic Emergency Medicine Volume 10, Number 5 440,
© 2003 Society for Academic
Emergency Medicine
PEDIATRICS |
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.
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Copyright © 2003 by the Society for Academic Emergency Medicine.
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