Document Type

Article

Publication Date

3-3-2025

Identifier

DOI: 10.1001/jamanetworkopen.2025.0160; PMCID: PMC11886727

Abstract

IMPORTANCE: Respiratory pathogen testing has been a common deimplementation focus. The COVID-19 pandemic brought new considerations for respiratory testing; recent trends in testing rates are not well understood.

OBJECTIVE: To measure trends in respiratory testing among encounters for acute respiratory infections among children and adolescents (aged <18 >years) from 2016 to 2023, assess the association of COVID-19 with these trends, and describe associated cost trends.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective serial cross-sectional study included emergency department (ED) encounters and hospitalizations in US children's hospitals among children and adolescents with a primary acute infectious respiratory illness diagnosis. Data were ascertained from the Pediatric Health Information System database from January 1, 2016, to December 31, 2023.

EXPOSURE: Respiratory pathogen testing.

MAIN OUTCOMES AND MEASURES: The primary outcome was the percentage of encounters with respiratory testing over time. Interrupted time series models were created to assess the association of COVID-19 with testing patterns. The inflation-adjusted standardized unit cost associated with respiratory testing was also examined.

RESULTS: There were 5 090 923 eligible encounters among patients who were children or adolescents (mean [SD] age, 3.36 [4.06] years); 55.0% of the patients were male. Among these encounters, 87.5% were ED only, 77.9% involved children younger than 6 years, and 94.5% involved children without complex chronic conditions. Respiratory testing was performed in 37.2% of all encounters. The interrupted time series models demonstrated increasing prepandemic testing rates in both ED-only encounters (slope, 0.26 [95% CI, 0.21-0.30]; P < .001) and hospitalizations (slope, 0.12 [95% CI, 0.07-0.16]; P < .001). Increases in respiratory testing were seen at the onset of the COVID-19 pandemic in both ED-only encounters (level change, 33.78 [95% CI, 31.77-35.79]; P < .001) and hospitalizations (level change, 30.97 [95% CI, 29.21-32.73]; P < .001), associated initially with COVID-19-only testing. Postpandemic testing rates remained elevated relative to prepandemic levels. The percentage of encounters with respiratory testing increased from 13.6% [95% CI, 13.5%-13.7%] in 2016 to a peak of 62.2% [95% CI, 62.1%-62.3%] in 2022. While COVID-19-only testing decreased after 2020, other targeted testing and large-panel (>5 targets) testing increased. The inflation-adjusted standardized unit cost associated with respiratory testing increased from $34.2 [95% CI, $33.9-$34.6] per encounter in 2017 to $128.2 [95% CI, $127.7-$128.6] per encounter in 2022.

CONCLUSIONS AND RELEVANCE: The findings of this cross-sectional study suggest that respiratory testing rates have increased over time, with large increases at the onset of the COVID-19 pandemic that have persisted. Respiratory testing rates and related costs increased significantly, supporting a need for future deimplementation efforts.

Journal Title

JAMA Netw Open

Volume

8

Issue

3

First Page

250160

Last Page

250160

MeSH Keywords

Humans; Child; Hospitals, Pediatric; Adolescent; COVID-19; Cross-Sectional Studies; Male; Female; United States; Retrospective Studies; Respiratory Tract Infections; Child, Preschool; Infant; SARS-CoV-2; Hospitalization; Emergency Service, Hospital; COVID-19 Testing

PubMed ID

40048166

Keywords

Pediatric Hospitals; COVID-19; Cross-Sectional Studies; United States; Retrospective Studies; Respiratory Tract Infections; SARS-CoV-2; Hospitalization; Hospital Emergency Service; COVID-19 Testing

Comments

This is an open access article distributed under the terms of the CC-BY License.

Publisher's Link: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831081

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