Aren't rvps like $1500? Wouldn't it be better to just trial a bronchodilator?Have a fancy lab with a respiratory viral panel and see if something comes up positive.
Or look for other symptoms (nasal congestion, rhinorrhea, fevers, conjunctivitis, sick contacts, etc), recognizing that some overlap with seasonal allergies, so you'll need to know if they have those and if they were exposed to any of their allergens.
We keep being told different things about the cost, and there's words going around that it's required for bed placement, which is very frustrating.Aren't rvps like $1500? Wouldn't it be better to just trial a bronchodilator?
Maybe I'm using the term wrong, but when I say RAD I guess I mean what I've heard called "transient wheeze of childhood/infancy"--what the adult medicine doctors in that article refer to as "not enough data in a young child" or someone who wheezes with viral illness as a toddler/until 3 y/o and then grows out of it
I think it's partly where the "only 30% of teeny kids who wheeze get asthma" comes fromThat's a far more useful paper.
Generally agree with this, but I will say that in the real world there is some additional value to these tests beyond "would it change management"I think the multiplex viral panels are useful only if they are going to change management*(cohort with other children with same disease process, forgo abx, forgo other testing to search for etiology of illness). They so sound very cool because we can say definitively "it's X" rather then "umm, probably a virus?". Ordered thoughtfully, they can be helpful.
However, I fear they will become an extension (a potentially much more expensive extension) of the RSV RADT. A test that tells you about exactly one virus and absolutely nothing about the child's hydration and respiratory status.
*Exceptions would include research and certain public health purposes.
I second that. It's a huge problem. People do not understand that it is only a panel of the 30 or so viral pathogens (some bacterial too) and that there are thousands more that are not tested. The worst is when people would take them off isolation precautions because the panel came back negative. At my institution we are lucky to have a very rational epidemiology dept who was able to change the culture. We now place people on isolation precautions when we suspect a viral respiratory infection, regardless of whether we order a panel or if it comes back negative. The other major issue is that insurance companies are starting to deny paying for this (and to be honest they should). It is an exceedingly expensive test for the little clinical benefit that it provides. I don't need a $1000 test to tell me that someone has a virus.Also, our nurses in the PICU have gotten into a habit of not putting kids in isolation unless there is an RVP ordered or a result from an OSH.
It's more like a $150 test.I don't need a $1000 test to tell me that someone has a virus.
How is deciding on contact precautions not the responsibility of the physician?! This seems like a major infectious control liability for the hospital if you are risking spreading a virus to other patients.Also, our nurses in the PICU have gotten into a habit of not putting kids in isolation unless there is an RVP ordered or a result from an OSH.
Had the same as an ED attending. Influenza B. Mom said prior to testing, "they told me yesterday this is a virus. My baby ain't got no virus."Generally agree with this, but I will say that in the real world there is some additional value to these tests beyond "would it change management"
Example -- parent got angry at me once because I told them their child had viral bronchiolitis. Patient got worse, went to hospital where they had a positive rapid RSV test. Parent was mad because their child had "RSV instead of a virus." Even though the management didnt change, knowing the specific virus causing the illness was highly valuable to the parent.
I would also say that these viral panels can change management in ways that you don't initially consider.
Example -- kid comes in with 6 days of fevers, weakness/fatigue, joint pains, conjunctivitis, large lymph node in neck. I'm starting to think about Kawasaki and perhaps admit them for IVIG. However I first run a viral panel which comes back positive for adenovirus. That has happened at least twice in my career, and now before I diagnose Kawasaki I always check for adeno first since it's such a great mimicker of Kawasaki
Now there are a couple of companies that can do a rapid FA6 viral panel with results in 2 hours that are much less expensive -- I saw one that costs under $30 for PPO insurance plans.