241 - Impact of the COVID-19 Pandemic on Viral Respiratory Testing Trends at U.S. Children's Hospitals

Poster Number: 241
Publication Number: 241.1859

Background: Reducing low-value viral respiratory testing has historically been an important target of quality improvement efforts given associated costs and lack of impact on management in many clinical scenarios. While the COVID-19 pandemic is known to have altered respiratory testing patterns, the subsequent trajectory of testing patterns is unknown.

Objective: To evaluate the impact of the COVID-19 pandemic on respiratory testing patterns and associated costs at U.S. children’s hospitals.

Design/Methods: We conducted a retrospective cohort study of encounters in the Pediatric Health Information System. We included emergency department (ED) and inpatient/observation encounters from July 2016 to June 2023 for patients < 18 years with a primary diagnosis of an acute infectious respiratory illness. We excluded hospitals with incomplete data over the study period and patients transferred in or out. We examined the percentage of encounters with respiratory testing and associated cost by year and encounter type (ED, non-intensive care unit (ICU) hospitalization, ICU hospitalization). We then assessed quarterly trends in testing over time by encounter and testing type: targeted COVID and other (targeted non-COVID (e.g., influenza, RSV) and non-targeted (i.e., multi-target)) testing.

Results: 4,444,390 encounters from 39 hospitals were included. Patient characteristics and overall testing rates are show in Table 1. Over the study period, the percentage of encounters with testing increased from 10-59% in the ED, 41-85% in non-ICU hospitalizations, and 77-92% in ICU hospitalizations (p < 0.001 for trend, Table 2). The cost of respiratory testing per encounter for respiratory illness increased from $33.19 per encounter in 2016-17 to $125.92 per encounter in 2022-23, representing a 3.8-fold increase (p < 0.001). There was an immediate increase in testing following the onset of the COVID-19 pandemic (Figure) driven by targeted COVID testing. Testing rates remained above pre-pandemic levels for all quarters thereafter. Seasonality in testing patterns is no longer seen after the onset of COVID-19. The percentage of encounters with targeted COVID testing decreased over time, while the percentage of encounters with other testing increased.

Conclusion(s): The percentage of encounters with viral respiratory testing increased with the onset of the COVID-19 pandemic and remains elevated above pre-pandemic levels. Associated testing cost per encounter for respiratory illness has increased nearly four-fold.