STUDY OBJECTIVE To evaluate for increases in the use and costs of respiratory viral testing in pediatric emergency departments (EDs) because of the COVID-19 pandemic. METHODS We performed a cross-sectional study using the pediatric health information system. Eligible subjects were children (90 days to 18 years) who were discharged from a pediatric ED and included in the pediatric health information system from October 2016 through March 2024. To evaluate for changes in the frequency and costs of respiratory viral testing, we performed an interrupted time series analysis across 3 study periods: prepandemic (October 1, 2016 to March 14, 2020), early pandemic (March 15, 2020 to December 31, 2023), and late pandemic (January 1, 2023 to March 31, 2024). RESULTS We included 15,261,939 encounters from 34 pediatric EDs over the 90-month study period. At least 1 viral respiratory test was performed for 460,826 of 7,311,177 prepandemic encounters (6.3%), 1,240,807 of 5,100,796 early pandemic encounters (24.3%), and 545,696 of 2,849,966 late pandemic encounters (19.1%). There was a positive prepandemic slope in viral testing (0.17% encounters/month; 95% CI 0.17 to 0.18). The early pandemic was associated with a shift change of 4.98% (95% CI 4.90 to 5.07) and a positive slope (0.54% encounters/month; 95% CI 0.54 to 0.55). The late pandemic period was associated with a negative shift (-17.80%; 95% CI -17.90 to -17.70) and a positive slope (0.42% encounters/month; 95% CI 0.41 to 0.42). The slope in testing costs increased from $5,000/month (95% CI $4,200 to $5,700) to $33,000/month (95% CI $32,000 to $34,000) during the early pandemic. CONCLUSION Respiratory testing and associated costs increased during the COVID-19 pandemic and were sustained despite decreasing incidence of disease. These findings highlight a need for further efforts to clarify indications for viral testing in the ED and efforts to reduce low-value testing.

中文翻译：

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COVID-19 大流行后儿科急诊科呼吸道病毒检测的趋势。


研究目的 评估由于 COVID-19 大流行而在儿科急诊科 （ED） 中呼吸道病毒检测的使用和成本增加。方法 我们使用儿科健康信息系统进行了一项横断面研究。符合条件的受试者是从儿科急诊科出院并于 2016 年 10 月至 2024 年 3 月被纳入儿科健康信息系统的儿童（90 天至 18 岁）。为了评估呼吸道病毒检测频率和成本的变化，我们在 3 个研究时期进行了间断时间序列分析：大流行前（2016 年 10 月 1 日至 2020 年 3 月 14 日）、大流行早期（2020 年 3 月 15 日至 2023 年 12 月 31 日）和大流行晚期（2023 年 1 月 1 日至 2024 年 3 月 31 日）。结果： 我们纳入了 90 个月研究期间来自 34 个儿科急诊科的 15,261,939 次就诊。对大流行前 7,311,177 次遭遇中的 460,826 次 （6.3%）、5,100,796 次大流行早期遭遇中的 1,240,807 次 （24.3%） 和 2,849,966 次大流行后期遭遇中的 545,696 次 （19.1%） 进行了至少 1 次病毒呼吸测试。病毒检测在大流行前呈阳性斜率（0.17% 次/月;95% CI 0.17 至 0.18）。大流行早期与 4.98% 的班次变化 （95% CI 4.90 至 5.07） 和正斜率 （0.54% 就诊次数/月;95% CI 0.54 至 0.55） 相关。大流行后期与负变化（-17.80%;95% CI -17.90 至 -17.70）和正斜率（0.42% 就诊次数/月;95% CI 0.41 至 0.42）相关。在大流行初期，检测费用的斜率从 5,000 美元/月（95% CI 4,200 美元至 5,700 美元）增加到 33,000 美元/月（95% CI 32,000 美元至 34,000 美元）。结论 在 COVID-19 大流行期间，呼吸检测和相关成本有所增加，尽管疾病发病率下降，但这种成本仍在持续。 这些发现强调需要进一步努力阐明急诊科病毒检测的适应症，并努力减少低价值检测。