Evaluating the Impact of Respiratory Pathogen Testing on Pediatric Emergency Department Return Visits and Management

Objectives: To determine whether limited versus comprehensive respiratory pathogen panel (RPP) testing in children discharged from the pediatric emergency department (PED) with a viral respiratory illness is associated with 7-day PED return visit rate and return visit management and disposition. Methods: We conducted a retrospective cohort study of children 61 days to 18 years of age discharged from a large urban PED between June 1, 2023 to August 31, 2023 and December 1, 2023 to February 29, 2024, who received either limited (SARS-CoV-2, influenza A/B, respiratory syncytial virus) or comprehensive (22 pathogens) RPP testing for a clinically diagnosed viral respiratory illness. We recorded basic demographics, RPP test results, 7-day PED returns, and interventions and disposition during return visits. Results: Of 2346 eligible patients, 1417 (60.4%) received limited RPP testing and 929 (39.6%) received comprehensive RPP testing. No difference was found in the 7-day PED return visit rate for limited testing compared with comprehensive testing after controlling for age, sex, race/ethnicity, insurance, Emergency Severity Index level, and visit season (aOR: 0.96, 95% CI: 0.67-1.38). On return visits, patients who had received limited testing were more likely to undergo additional urine studies (aOR: 2.70, 95% CI: 1.16-6.84); no differences were found in additional blood tests, throat swabs, chest radiographs, IV placements, medication administration, antibiotic prescribing, or disposition. Conclusions: Limited RPP testing is likely sufficient for children with a viral respiratory illness in the outpatient setting, as comprehensive RPP testing was not associated with a reduction in 7-day return visits or return visit interventions.