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Why get RSV tests
Aug
18
I'm impressed at the RSV showing up everywhere
and I have not seen any RSV-like disease yet is Sheridan, Wyoming, but, I must
admit, I am very frugal with RSV tests. Why test so
much? How does it change your management? What do you do
differently with RSV positive bronchiolitis and you don't do with RSV negative
bronchiolitis.
I don't test much. I treat bronchiolitis
as bronchiolits. I isolate ALL wheezing babies I need to admit as if they
were RSV positive. (I"ve seen kids that I KNEW had bronchiolitis test
negative the first day and positive later in the
admission.) I hate dealing with RSV hysteria when it
gets started in the community.
I do test infants two months and younger with
wheezing because a positive makes me more likely to admit for observation for
apnea, but even then I question it. The test here costs $69 at the
hospital and none of the docs in town do the office test, as far as I
know.
Barry in Sheridan,
Wyoming
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Why get RSV tests
care4kids wrote:
> I'm impressed at the RSV showing up everywhere and I have not seen
> any RSV-like disease yet is Sheridan, Wyoming, but, I must admit, I am
> very frugal with RSV tests. Why test so much? How does it change
> your management? What do you do differently with RSV positive
> bronchiolitis and you don't do with RSV negative bronchiolitis.
>
> I don't test much. I treat bronchiolitis as bronchiolits. I isolate
> ALL wheezing babies I need to admit as if they were RSV positive.
> (I"ve seen kids that I KNEW had bronchiolitis test negative the first
> day and positive later in the admission.) I hate dealing with RSV
> hysteria when it gets started in the community.
>
> I do test infants two months and younger with wheezing because a
> positive makes me more likely to admit for observation for apnea, but
> even then I question it. The test here costs $69 at the hospital and
> none of the docs in town do the office test, as far as I know.
>
> Barry in Sheridan, Wyoming
You make an excellent point. I would love to stop testing. We test as
part of a hospital policy that requires cohorting of RSV bronchiolitis
separate from RSV-negative bronchiolitis separate from
non-bronchiolitics.
Although some people feel that RSV is treated differently, I agree with
you. Adenovirus can cause apnea, too. I won't even get started on how
little I like Ribavirin.
The truth is that if everyone washes their hands well, nosocomial RSV is
exceedingly rare. I had an RSV-negative patient who, out of
overcrowding necessity, was in a room with two RSV positive patients for
over a week. She remained negative because we were diligent about
handwashing. The whole staff jumped on the handwashing bandwagon with
her because they knew she was at risk, but it proves the point quite
well.
After having cared for nearly 100 kids with bronchiolitis last winter,
I'd love to stop testing and have one less useless piece of information
to deal with.
Incidentally, I cannot think of ANY reason to test a child for RSV if
they are not going to be admitted to the hospital.
--
Andrew M. Eisen, MD
Assistant Professor of Pediatrics
Associate Director, Pediatric Residency Program
University of Nevada School of Medicine
hidden@email-address
Why get RSV tests
OK, just for the sake of debate, it is sometimes nice to have the laboratory
confirmation of a positive RSV for the following reasons:
1- Statistically I can give the parents anticipatory guidance regarding the
potencial for future wheezing episodes and puts a little extra "umph" in my
stern warnings to avoid extra asthma triggers.
2.- I can pretty much be forewarned that the otitis that comes with it is
not going to respond to antibiotics and is going to be a pain to deal with.
3.- In babies who have significant family history of RAD, I tend to start
Intal at the end of the bronchiolitis episode to try to quiet future
wheezing episodes.
4.- I like to know my enemy's full name, not just its surname--"virus".
5.- I sound like a genius when I tell the parents it's not going to go away
overnight.
6.- Once in a blue moon you'll have a wheezing child who presents during
bronchiolitis season who is RSV negative and actually makes you wake up and
expand your differencial diagnosis to include all the things that wheeze
that are not RSV.
If I keep going David Letterman might be upset so I'll stop now.
Regards- Kim Burlingham, MD FAAP
From: Andrew M. Eisen, MD
To: Ped Talk
Date: Tuesday, August 18, 1998 10:54 AM
Subject: Re: Why get RSV tests
>
>
>care4kids wrote:
>
>> I'm impressed at the RSV showing up everywhere and I have not seen
>> any RSV-like disease yet is Sheridan, Wyoming, but, I must admit, I am
>> very frugal with RSV tests. Why test so much? How does it change
>> your management? What do you do differently with RSV positive
>> bronchiolitis and you don't do with RSV negative bronchiolitis.
>>
>> I don't test much. I treat bronchiolitis as bronchiolits. I isolate
>> ALL wheezing babies I need to admit as if they were RSV positive.
>> (I"ve seen kids that I KNEW had bronchiolitis test negative the first
>> day and positive later in the admission.) I hate dealing with RSV
>> hysteria when it gets started in the community.
>>
>> I do test infants two months and younger with wheezing because a
>> positive makes me more likely to admit for observation for apnea, but
>> even then I question it. The test here costs $69 at the hospital and
>> none of the docs in town do the office test, as far as I know.
>>
>> Barry in Sheridan, Wyoming
>
>You make an excellent point. I would love to stop testing. We test as
>part of a hospital policy that requires cohorting of RSV bronchiolitis
>separate from RSV-negative bronchiolitis separate from
>non-bronchiolitics.
>
>Although some people feel that RSV is treated differently, I agree with
>you. Adenovirus can cause apnea, too. I won't even get started on how
>little I like Ribavirin.
>
>The truth is that if everyone washes their hands well, nosocomial RSV is
>exceedingly rare. I had an RSV-negative patient who, out of
>overcrowding necessity, was in a room with two RSV positive patients for
>over a week. She remained negative because we were diligent about
>handwashing. The whole staff jumped on the handwashing bandwagon with
>her because they knew she was at risk, but it proves the point quite
>well.
>
>After having cared for nearly 100 kids with bronchiolitis last winter,
>I'd love to stop testing and have one less useless piece of information
>to deal with.
>
>Incidentally, I cannot think of ANY reason to test a child for RSV if
>they are not going to be admitted to the hospital.
>
>--
>Andrew M. Eisen, MD
>Assistant Professor of Pediatrics
>Associate Director, Pediatric Residency Program
>University of Nevada School of Medicine
>hidden@email-address
>
>
>
> To unsubscribe: mail "hidden@email-address" with with "unsubscribe"
>
>
Why get RSV tests
Certainly testing for RSV with complicated pulmonary disease
makes sense. My impression is that 99% of the RSV tests ordered are
for uncomplicated bronchiolitis, and, in that situation, I wonder if testing
doesn't do far more harm than good.
The Peds ID folks at Denver Children's have been recommending
against testing for isolation purposes for the last couple of RSV seasons
(unless the situation is unusual, like your patient with pulmonary vasculitis on
Imuran). They recommend for patients admitted, cohorting by like
symptoms, that is, isolating together all wheezing infants.
By the way, how does RSV positive/negative
affect your willingness to use nebs/steroids/oxygen/monitors for the routine
infant with wheezing severe enough to need admission?
Barry in Sheridan, Wyoming
Barry M. Wohl, M.D.
Northeast Wyoming Pediatric Associates, P.C.