Impact of in‐hospital enteroviral polymerase chain reaction testing on the clinical management of children with meningitis
Enteroviral meningitis is a common cause of meningitis in children which requires only supportive care.
To evaluate the impact of implementing an in‐hospital enteroviral polymerase chain reaction (EVPCR) testing protocol on the clinical management of children with meningitis.
Retrospective cohort study.
Children <19 years old with meningitis.
EVPCR testing differed by time period: send‐out testing protocol from July 1, 2006–June 23, 2008 (pre‐period) versus in‐house testing protocol from June 24, 2008–June 30, 2010 (post‐period).
Test turnaround time, test utilization, length of stay, and duration of parenteral antibiotics.
Of the 441 study patients, 216 (49%) presented during the post‐period. Median age was 2.9 months (interquartile range, 1.5–96 months). Test turnaround time decreased with the in‐house test (53 hours pre vs 13 hours post, P < 0.001), and test utilization increased (28% pre vs 62% post, P < 0.001). Among children with a positive EVPCR test, both length of stay (44 hours pre vs 28 hours post, P = 0.005) and duration of parenteral antibiotics (48 hours pre vs 36 hours post, P = 0.04) decreased in the post‐period. No change in either of these outcomes was observed in children with meningitis and a negative EVPCR test.
In‐house EVPCR testing reduced test turnaround time, increased test utilization, and reduced both length of stay and duration of parenteral antibiotics for children with a positive result. Clinicians caring for children with meningitis should have access to in‐hospital EVPCR testing. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine