Abstract
ABSTRACTBackground: Palivizumab prophylaxis against respiratory syncytial virus (RSV) infection has been widely adopted for high-risk infants during the RSV season, based on country-specific guidelines.Objective: To determine if a validated, risk-scoring tool (RST), can be applied to term, RSV-positive infants seen in the emergency room (ER) to predict need for hospitalization, in order to target prophylaxis cost effectively at a selected group of children.Design: Retrospective, descriptive study.Setting: McMaster Children's Hospital in Hamilton, Ontario, Canada.Participants: A total of 72, consecutive, term, RSV-positive cases were identified retrospectively, from November through April during the 2006––2007 RSV season.Methods: A questionnaire/chart review was conducted on 68 of 72 cases, to determine risk categories based on the RST. Four, trained abstractors, extracted pertinent data from the medical records of RSV-positive patients. Means, standard deviations (SD), and percents were used to describe the study variables for hospitalized and ER patients discharged home. Chi-square tests were used to compare infants’’ risk factors to hospitalization. ANOVA was used for comparisons within and between risk groups and RST scores. A p-value of <0.05 was considered statistically significant.Results: The majority of infants scored in the low-risk category (n == 44), versus moderate (n == 16) or high risk (n == 8). Within the low-risk category, 27 (61%%) of children were admitted to hospital compared to 17 (39%%) who were treated in the ER and discharged home. The mean RST scores for those admitted to the pediatric intensive care unit/ward, the ward only, or those discharged home from the ER were 48.3 (n == 10), 41.0 (n == 36), and 36.5 (n == 22), respectively (p == 0.17). The mean number of risk factors for those discharged home versus hospitalized patients was 2.5 (1.3) and 2.97 (1.13), respectively (p == 0.15). Only two of eight cases in the high-risk group required intensive care.Conclusions: Overall, the risk-scoring tool did not discriminate between low versus moderate- to high-risk RSV-positive term infants who require hospitalization which has cost implications, since universal prophylaxis of this cohort would be financially prohibitive. A larger study is necessary to establish risk factors that more accurately determine RSV hospitalization among term infants.
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