A new study reveals a more targeted approach to respiratory virus testing in children could considerably reduce unnecessary tests. Pediatricians at Children’s Hospital Los Angeles and University of Southern California presented their findings at the ASM Microbe 2025 meeting, in Los Angeles.

Respiratory tract infections (RTIs) are a frequent reason for children to visit the emergency department (ED). While a respiratory viral panel (RVP) offers speedy results and can be crucial in diagnosing an RTI, indiscriminate use can be costly. Researchers investigated which patients truly benefit from RVP testing.

The study involved a retrospective evaluation of 400 patients aged five and under who underwent RVP testing in the ED. The results were evenly split: half positive for a respiratory virus, half negative.

Researchers found that 93% of the children had no prior medical history. Interestingly, fever alone was not a strong indicator of a positive RVP result.

However, positive RVP results did show a significant correlation with several RTI symptoms: cough (P<0.0101), nasal congestion (P<0.0001), rhinorrhea (P<0.0001) and dyspnea (P<0.0231). Despite these correlations, relying solely on these symptoms would still led to overuse of RVP tests. The team then explored additional criteria to refine testing practices.

Refining Testing Criteria

The refined criteria included: neonates (<60 days old) with a documented fever (38°C),critically ill or immunocompromised children with fever and/or RTI symptoms,and children with a documented fever lasting at least five days.

“We found a significant reduction of unnecessary testing in the ED when criteria were applied to a retrospective cohort of patients.”

The study found that implementing these criteria could have eliminated 52% of negative tests while retaining 82% of positive tests (P<0.0001), leading to significant cost and time savings.

The researchers concluded: “We found a significant reduction of unnecessary testing in the ED when criteria were applied to a retrospective cohort of patients. Further studies are needed to establish stewardship guidelines across pediatric institutes to provide cost-effective RVP testing.”