Ninety-three patients were hospitalized at Children’s Memorial from fall 1997 through spring 1998 with an admitting or a discharge principal or a secondary diagnosis of RSV infection. Five of these cases were classified as noso-comial infections, as defined by the lack of respiratory symptoms on admission, the development of RSV infection more than 96 hours after admission, or the occurrence of RSV infection within 96 hours of a previous hospital admission, based on the usual incubation period for RSV and on our hospital’s infection-control policies.

The charts of four patients were unavailable for review (two in the ward group and two in the ward + PICU + ventilation group). In nine instances, a confirmed RSV infection was an incidental finding and was not the cause of the patient’s hospitalization. This was true for eight patients in the ward group and for one patient in the ward + PICU + ventilation group; thus, these patients were not included in our analysis. Apcalis Oral Jelly

As examples, one patient who had been admitted with nephrotic syndrome and Streptococcus pneumoniae bac-teremia, a second patient who had been admitted with a complication of sickle cell disease, a third patient who had been admitted with Henoch-Schonlein purpura, and a neonate who had been admitted with indirect hyperbili-rubinemia were found to be RSV-positive but required no oxygen and were not in respiratory distress throughout their hos-pitalizations. A fifth patient, who had recently undergone liver transplantation, was admitted for portal vein thrombosis and was found to be RSV-positive; she too required no oxygen and experienced no respiratory distress throughout her hos-pitalization. Our analysis focuses on the remaining 80 patients.

The demographics of the study population are shown in Table 1. About two-thirds of the patients were black or Hispanic, accurately reflecting the demographics of the population at Children’s Memorial and the demographics of RSV infection. There was a predominance of boys (47 of 80, or 59%) and children receiving public aid (52 of 80, or 65%), again, as would be expected from the demographics. The median age of the patients studied was 23.2 months, with slightly older children (median age, 34 months) requiring PICU monitoring and younger children (median age, eight months) requiring mechanical ventilation.

Table 1 Demographics of Study Patients with Respiratory Syncytial Virus Infection

Ward Ward+ PICU Ward + PICU+ Ventilator Total
Race/ethnicity
White

10

4

7

21

Black

14

6

2

22

Hispanic

25

3

1

29

Asian

1

0

1

2

Not available

5

0

1

6

Sex
Male

35

6

6

47

Female

20

7

6

33

Age (mo.)
Median

24

34

8

23.2

(range,

(range,

(range,

0.5-120)

15-138)

1-37)

<12 months

15

0

7

22

12-24 months

14

6

4

24

<36 weeks’ gestation

2

1

3

6

Public aid

38

8

6

52

Total

55

13

12

80

PICU = pediatric intensive-care unit.

Nine of the 12 patients (75%) who experienced respiratory failure that necessitated mechanical ventilation had a known risk factor for increased complications because of RSV (mainly pre-existing heart disease). The same was true for four of the 13 patients (31%) who had been admitted to the PICU but who were not undergoing ventilation and for nine of the 55 patients (16%) who had been admitted to the ward service alone. canadian pharmacy cialis

Children who required ventilation were thus more likely to have risk factors for RSV infection than children who had been admitted to the hospital (either to the ward or to the PICU) and who did not receive ventilation (the chi square for this distribution was equal to 0.001). Two of the 55 patients (4%) who had been admitted to the ward only, one of 13 patients who had been admitted to the PICU but who had not received ventilator therapy (8%), and three of the 12 patients admitted to the PICU who needed mechanical ventilation (25%) had been born at less than 36 weeks of gestation.

Table 2 Costs, Charges, and Lengths of Stay of Patients Hospitalized with Respiratory Syncytial Virus Infection

Mean Cost per Case:
No. Mean Charge per Case Charge x 0.67

Mean Length of Stay

Ward admission only 55 $7,518  (range, $1,488-$44,719) $5,037

2 days   (range, 1-21 days)

Ward + PICU 13 $26,329 (range, $4,595-$57,837) $17,640

8.5 days (range, 1-15 days)

Ward + PICU + ventilator 12 $42,940 (range, $7,958-$92,229) $28,770

8 days   (range, 1-17 days)

Total 80
PICU = pediatric intensive-care unit.

Bronchiolitis was the diagnosis in two of 13 patients in the PICU (15%), in four of 12 patients who required mechanical ventilation (33%), and in all but 11 patients admitted to the ward (80%). Other diagnoses associated with RSV infection in our population included croup, pneumonia, and prolonged intubation.
Table 2 lists the mean charges per case, mean costs per case (using our institution’s RSV charge x 0.67), and mean length of stay for each group. The weighted mean charge, mean cost, and mean length of stay overall for the entire study population was $15,841; $10,613; and 3.9 days, respectively.