Clinical Report: Impact of Acute Respiratory Infections on Pediatric ER Visits Under 5

Overview

The RISE study evaluated acute respiratory infections (ARI) in children under 5 presenting to a Berlin emergency room during the 2023/24 winter season. Multiplex-PCR identified key viral pathogens, revealing pathogen-specific trends and hospitalization rates, with RSV, influenza, and rhinovirus as predominant causes. Antibiotic prescription patterns were also analyzed in relation to viral diagnostics.

Background

Acute respiratory infections are a major cause of pediatric emergency room visits and hospitalizations, especially in children under five years old. Viruses such as RSV, rhinovirus, and influenza are common etiologies, with RSV notably contributing to high morbidity and mortality in this age group. Seasonal peaks typically occur in winter months, but the specific pathogen distribution and hospitalization rates in ER settings are not well characterized. The RISE study aimed to fill this knowledge gap by prospectively collecting clinical and virological data from children presenting with ARI symptoms.

Data Highlights

Key Findings

• RSV, influenza, and rhinovirus were the most frequently detected pathogens in children presenting with ARI.
• RSV infections were associated with higher morbidity and hospitalization rates, especially in children under 6 months.
• Multiplex-PCR testing enabled pathogen-specific diagnosis, influencing antibiotic prescription decisions.
• Most children with ARI presented with upper respiratory tract infections, but lower respiratory tract infections had higher hospitalization rates.
• Co-infections were classified with RSV or influenza as primary pathogens when present alongside others.
• Seasonal timing of RSV and influenza infections aligned with national surveillance data from the Robert Koch-Institute.

Clinical Implications

Rapid multiplex-PCR testing in the emergency room setting can improve pathogen-specific diagnosis of ARI in young children, guiding more targeted antibiotic use and management decisions. Awareness of the high burden of RSV, particularly in infants, underscores the need for preventive strategies and preparedness during peak seasons. Differentiating URTI from LRTI presentations can help identify children at higher risk for hospitalization.

Conclusion

The RISE study provides valuable prospective data on the epidemiology and clinical impact of viral ARI in children under five in the ER setting. These findings support the integration of multiplex viral diagnostics to optimize patient care and inform public health interventions during respiratory virus seasons.

References

1. Robert Koch-Institute 2023/24 -- RSV and Influenza Season Data
2. QIAstat-Dx Respiratory SARS-CoV-2 Panel -- Multiplex PCR Testing
3. RISE Study Protocol Eth-56/23 -- Study Design and Ethics