Impact of a diagnostic cerebrospinal fluid enterovirus polymerase chain reaction test on patient management.

Abstract

Enterovirus (EV) infection, the most common cause of aseptic meningitis, can be rapidly diagnosed with an EV-specific reverse transcriptase polymerase chain reaction (EV-PCR) test. However, no studies have examined EV-PCR in a clinical context in which it is routinely used. To determine the impact of EV-PCR testing on diagnosis and clinical management of suspected aseptic meningitis cases. Retrospective review of electronic medical records from a 220-bed tertiary care pediatric medical center in San Diego, Calif. A total of 276 pediatric patients for whom a diagnostic EV-PCR test was performed during the calendar year 1998. Clinical parameters such as length of stay, medication use, and ancillary test use. One hundred thirty-seven patients (49.6%) had a positive cerebrospinal fluid EV-PCR result. Enterovirus-positive patients with results available before hospital discharge (n=95) had significantly fewer ancillary tests performed (26% vs 72% with at least 1 test performed; P<.001), received intravenous antibiotics for less time (median, 2.0 vs 3.5 days; P<.001), and had shorter hospital stays (median, 42 vs 71.5 hours; P<.001) than EV-negative patients (n=92). A positive EV-PCR result was associated with more rapid hospital discharge (median EV-PCR-to-discharge time, 5.2 hours) compared with a negative result (median EV-PCR-to-discharge time, 27.4 hours; P<.001). Our results suggest that a positive EV-PCR result may affect clinical decision making and can promote rapid discharge of patients, and that unnecessary diagnostic and therapeutic interventions can be reduced by use of EV-PCR testing. JAMA. 2000;283:2680-2685.