Appropriateness of respiratory virus screening among hospitalized patients with respiratory symptoms: A retrospective observational study.

BACKGROUND

Respiratory viruses such as SARS-CoV-2, influenza, and RSV place considerable pressure on healthcare systems. Inconsistent respiratory virus screening among hospitalized patients with respiratory symptoms may delay recognition of respiratory viral infections and implementation of appropriate infection prevention and control measures.

OBJECTIVE

To assess the appropriateness of respiratory virus screening among hospitalized patients with respiratory symptoms and to identify factors associated with inappropriate screening.

METHODS

We conducted a retrospective observational study in a 2500-bed tertiary hospital in Belgium during three periods of the 2022-2023 influenza epidemic. Medical records were reviewed for demographic and clinical characteristics, respiratory symptoms, and respiratory virus screening practices. Screening was classified as appropriate or inappropriate (delayed or absent despite indication) based on prevailing guidelines. Determinants of inappropriate screening were explored using univariable analyses.

RESULTS

Of 743 hospital admissions assessed for eligibility, 345 (46%) involved patients with respiratory symptoms and constituted the primary analysis population. Respiratory virus screening was appropriate in 75% (258/345) and inappropriate in 25% (87/345) of cases. Appropriate screening was more frequent among patients admitted for respiratory conditions and among those meeting criteria for severe acute respiratory infection (SARI). Screening appropriateness was significantly lower among patients who developed respiratory symptoms during hospitalization than among those with symptoms documented at admission (37% vs. 77%, p < 0.001). Isolation status could not be reliably determined for 44% of patients and was therefore considered descriptive only.

CONCLUSION

Gaps remain in appropriate respiratory virus screening among hospitalized patients with respiratory symptoms, particularly among patients who develop symptoms during hospitalization. Systematic symptom-based screening and standardized decision-support tools may help improve adherence to respiratory virus screening recommendations.