Association of Herpes Simplex Virus Testing with Hospital Length of Stay for Infants ≤60 Days of Age Undergoing Evaluation for Meningitis

Journal of Hospital Medicine 14(8). 2019 August;:492-495 | 10.12788/jhm.3202

May 10, 2019|Journal of Hospital Medicine

Paul L Aronson, MD, MHS;Andrea T Cruz, MD, MPH;Stephen B Freedman, MDCM, MSc;Fran Balamuth, MD, PhD, MSCE;Kendra L Grether-Jones, MD;Todd W Lyons, MD, MPH;Alesia H Fleming, MD, MPH;Jeffrey Louie, MD;Rakesh D Mistry, MD, MS;Aris C Garro, MD, MPH;Samir S Shah, MD, MSCE;Lise E Nigrovic, MD, MPH;for the Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus (HSV) Study Group

Although neonatal herpes simplex virus (HSV) causes significant morbidity, utilization of the cerebrospinal fluid (CSF) HSV polymerase chain reaction (PCR) test remains variable. Our objective was to examine the association of CSF HSV PCR testing with length of stay (LOS) in a 20-center retrospective cohort of hospitalized infants aged ≤60 days undergoing evaluation for meningitis after adjustment for patient-level factors and clustering by center. Of 20,496 eligible infants, 7,399 (36.1%) had a CSF HSV PCR test performed, and 46 (0.6% of those tested) had a positive test. Infants who had a CSF HSV PCR test performed had a 23% longer hospital LOS (incident rate ratio 1.23; 95% CI: 1.14-1.33). Targeted CSF HSV PCR testing may mitigate the impact on LOS for low-risk infants.

CONCLUSIONS

For infants aged ≤60 days undergoing evaluation for meningitis, CSF HSV PCR testing was associated with a slightly longer hospital LOS. Improved methods to identify and target testing to higher risk infants may mitigate the impact on LOS for low-risk infants.

Acknowledgments

The authors acknowledge the following collaborators in the Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus (HSV) Study Group who collected data for this study and/or the parent study: Joseph L Arms, MD (Minneapolis, Minnesota), Stuart A Bradin, DO (Ann Arbor, Michigan), Sarah J Curtis, MD, MSc (Edmonton, Alberta, Canada), Paul T Ishimine, MD (San Diego, California), Dina Kulik, MD (Toronto, Ontario, Canada), Prashant Mahajan, MD, MPH, MBA (Ann Arbor, Michigan), Aaron S Miller, MD, MSPH (St. Louis, Missouri), Pamela J Okada, MD (Dallas, Texas), Christopher M Pruitt, MD (Birmingham, Alabama), Suzanne M Schmidt, MD (Chicago, Illinois), David Schnadower, Amy D Thompson, MD (Wilmington, Delaware), Joanna E Thomson, MD, MPH (Cincinnati, Ohio), MD, MPH (St. Louis, Missouri), and Neil G. Uspal, MD (Seattle, Washington).

Disclosures

Dr. Aronson reports grants from the Agency for Healthcare Research and Quality during the conduct of the study. Dr. Shah reports grants from Patient-Centered Outcomes Research Institute, grants from the National Institute of Allergy and Infectious Diseases, and grants from the National Heart Lung Blood Institute, outside the submitted work. Dr. Shah is the Editor-in-Chief of the Journal of Hospital Medicine. All other authors have no conflicts of interest or financial relationships relevant to this article to disclose.

Funding

This project was supported by the Section of Emergency Medicine of the American Academy of Pediatrics (AAP) and Baylor College of Medicine and by the grant number K08HS026006 (Aronson) from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. Stephen Freedman is supported by the Alberta Children’s Hospital Foundation Professorship in Child Health and Wellness.