Utility of a Multiplex Molecular Respiratory Pathogen Panel on Clinical Management of Children in the Pediatric Emergency Department.

Acute respiratory infections in children contribute to a significant volume of pediatric emergency department (PED) visits annually. Rapid molecular respiratory pathogen panels (RPPs) have increasingly been integrated into diagnostic workup. This study aims to investigate RPPs' impact on clinical management of children presenting to the PED and the effect of implementing restrictive criteria for RPP orders. Retrospective analysis of PED RPP orders from June 2023 through June 2024 was performed with a randomized subset of 400 patients in two cohorts (infants <1 year old and children 1 to 5 years old) selected for in-depth chart abstraction, including clinical presentation and management, with even distribution of RPP-positive and RPP-negative patients. Of 2052 RPPs performed from children age 5 years or younger, 1464 (71.3%) were positive for one or more targets. Regardless of RPP result or patient age, no significant differences in disease severity (mean Emergency Severity Index of 3.7 versus 3.7) or clinical management (infants, 6.0%; young children, 5.0%) were observed. Applying stewardship criteria retrospectively to both cohorts demonstrated a potential 48% reduction in unnecessary testing by RPP. RPP results, positive or negative for one or more targets, had limited impact on clinical management in the PED. The data support the potential value of stewardship intervention to reduce cost while maintaining critical pathogen identification.