A Multicenter Outcomes Analysis of Children With Severe Rhino/Enteroviral Respiratory Infection*

Objectives To investigate the impact of human rhino/enteroviruses on morbidity and mortality outcomes in children with severe viral respiratory infection. Design Retrospective cohort study. Setting The ICU, either PICU or cardiac ICU, at three urban academic tertiary-care children's hospitals. Patients All patients with laboratory-confirmed human rhino/enteroviruses infection between January 2010 and June 2011. Interventions We captured demographic and clinical data and analyzed associated morbidity and mortality outcomes. Measurements and main results There were 519 patients included in our analysis. The median patient age was 2.7 years. The median hospital and ICU lengths of stay were 4 days and 2 days, respectively. Thirty-four percent of patients had a history of asthma, and 25% of patients had a chronic medical condition other than asthma. Thirty-two percent of patients required mechanical ventilation. Eleven patients (2.1%) did not survive to hospital discharge. The rate of viral coinfection was 12.5% and was not associated with mortality. Predisposing factors associated with increased mortality included immunocompromised state (p < 0.001), ICU admission severity of illness score (p < 0.001), and bacterial coinfection (p = 0.003). Conclusions There is substantial morbidity associated with severe respiratory infection due to human rhino/enteroviruses in children. Mortality was less severe than reported in other respiratory viruses such as influenza and respiratory syncytial virus. The burden of illness from human rhino/enteroviruses in the ICU in terms of resource utilization may be considerable.