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Christian Ramers, BS; Glenn Billman, MD; Michele Hartin, MT(ASCP) SM; Sandy Ho, MS; Mark H. Sawyer, MD

JAMA. 2000;283:2680-2685.

Context  Enterovirus (EV) infection, the most common cause of aseptic meningitis, can be rapidly diagnosed with an EV-specific reverse transcriptase polymerase chain reaction (EV-PCR) test. However, no studies have examined EV-PCR in a clinical context in which it is routinely used.

Objective  To determine the impact of EV-PCR testing on diagnosis and clinical management of suspected aseptic meningitis cases.

Design and Setting  Retrospective review of electronic medical records from a 220-bed tertiary care pediatric medical center in San Diego, Calif.

Patients  A total of 276 pediatric patients for whom a diagnostic EV-PCR test was performed during the calendar year 1998.

Main Outcome Measures  Clinical parameters such as length of stay, medication use, and ancillary test use.

Results  One hundred thirty-seven patients (49.6%) had a positive cerebrospinal fluid EV-PCR result. Enterovirus-positive patients with results available before hospital discharge (n=95) had significantly fewer ancillary tests performed (26% vs 72% with at least 1 test performed; P<.001), received intravenous antibiotics for less time (median, 2.0 vs 3.5 days; P<.001), and had shorter hospital stays (median, 42 vs 71.5 hours; P<.001) than EV-negative patients (n=92). A positive EV-PCR result was associated with more rapid hospital discharge (median EV-PCR–to–discharge time, 5.2 hours) compared with a negative result (median EV-PCR–to–discharge time, 27.4 hours; P<.001).

Conclusions  Our results suggest that a positive EV-PCR result may affect clinical decision making and can promote rapid discharge of patients, and that unnecessary diagnostic and therapeutic interventions can be reduced by use of EV-PCR testing.

Author Affiliations: School of Medicine, Division of Pediatric Infectious Diseases, University of California, San Diego (Mr Ramers, Ms Ho, and Dr Sawyer); Departments of Pathology and Microbiology, Children's Hospital and Health Center, San Diego, Calif (Dr Billman and Ms Hartin).

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