Impact of decreasing cerebrospinal fluid enterovirus PCR turnaround time on costs and management of children with suspected enterovirus meningitis
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To estimate the impact of implementing in-hospital enterovirus (EV) polymerase chain reaction (PCR) testing of cerebrospinal fluid (CSF) with same-day turn-around-time (TAT) on length-of-stay (LOS), antibiotic use and on cost per patient with suspected EV meningitis, compared with testing at an outside reference laboratory. A model-based analysis using a retrospective cohort of all hospitalized children with CSF EV PCR testing done between November 2013 and 2017. The primary outcome measured was the potential date of discharge if the EV PCR result had been available on the same day. Patients with positive EV PCR were considered for potential earlier discharge once clinically stable with no reason for hospitalization other than intravenous antibiotics. Descriptive statistics and cost-sensitivity analyses were performed. CSF EV PCR testing was done on 153 patients, of which 44 (29%) had a positive result. Median test TAT was 5.3 days (IQR 3.9–7.6). Median hospital LOS was 5 days (IQR 3–12). Most (86%) patients received intravenous antibiotics with mean duration of 5.72 ± 6.51 days. No patients with positive EV PCR had a serious bacterial infection. We found that same-day test TAT would reduce LOS and duration of intravenous antibiotics by 0.50 days (95%CI 0.33–0.68) and 0.67 days (95%CI 0.42–0.91), respectively. Same-day test TAT was associated with a cost reduction of 342.83CAD (95%CI 178.14–517.00) per patient with suspected EV meningitis. Compared with sending specimens to a reference laboratory, performing CSF EV PCR in-hospital with same-day TAT was associated with decreased LOS, antibiotic therapy, and cost per patient.
KeywordsMolecular diagnostic techniques Central nervous system Economic evaluation Simulated cohort Pleocytosis Infant Newborn
Central nervous system
Length of stay
McGill University Health Centre
Polymerase chain reaction
Serious bacterial infection
This work was supported by the Fonds de recherche Québec santé (to J.P. and C.P.Y.). The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The other authors received no external funding. The authors have no financial disclosures to declare.
Compliance with ethical standards
This study was approved by the McGill University Health Centre research ethics board (2018–4190).
Conflict of interest
J.P. has received consulting/honoraria fees or research grant funding outside of the current work from the following: AbbVie; BD Diagnostics; Cepheid; MedImmune; Hoffmann-La Roche; Jannsen Pharmaceutical; Seegene. C.C. has received honoraria fees outside of the current work from Roche Diagnostics Canada. C.P.Y. has received in-kind support for investigator-initiated research projects from bioMérieux and BD Diagnostics in the last 3 years. The remaining authors declare no conflicts of interest.
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