Association Between Rapid Viral Testing and Reduced Length of Stay in a Pediatric Emergency Department During Epidemic Seasons: Implications for Overcrowding Management

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Overcrowding in emergency departments (EDs), particularly pediatric emergency departments (PEDs), remains a significant challenge affecting patient outcomes and healthcare efficiency. Rapid diagnostic tests (RDTs) for respiratory viruses offer a potential approach to enhance patient management through prompt etiological diagnoses. This study evaluated the impact of point-of-care RDTs for influenza and adenovirus on length of stay (LOS) in a tertiary PED during epidemic seasons. Methods. A retrospective cohort study was conducted at IRCCS Istituto Giannina Gaslini, Genoa, Italy, over two epidemic seasons (December–February, 2023–2025). Pediatric patients with fever and respiratory symptoms who underwent bedside RDTs for influenza and/or adenovirus were included. LOS was assessed as time from triage to discharge (TTD) and physician acceptance to discharge (ATD). Patients were stratified by RDT results. Analyses between groups used Mann–Whitney U-test for continuous variables and chi-square or Fisher's exact test for categorical variables. A two-tailed p-value < 0.05 was considered significant. Results. Of 1,238 analyzed patients, median age was 3.3 years (IQR 1.4–7.2), with male predominance (58.1%). Overall, 330 patients (26.6%) tested positive for at least one virus. Positive RDT results showed shorter median TTD (217.0 vs. 239.0 minutes, p < 0.001) and ATD (66.0 vs. 148.5 minutes, p < 0.001) compared to negative results. These findings were consistent across virus types. No significant difference in 72-hour readmission rates was observed between groups, suggesting safe early discharge. Conclusions. RDTs for influenza and adenovirus in febrile pediatric patients with respiratory symptoms reduced PED LOS without increasing early return visits. These findings demonstrate RDTs' value in optimizing patient flow and reducing PED overcrowding. Future prospective studies and development of RDTs for additional respiratory pathogens are warranted to enhance emergency care efficiency. Adenovirus Emergency Department Overcrowding Fever Influenza Length of Stay Pediatric Emergency Department Point-of-Care Testing Rapid Diagnostic Tests Respiratory Infections Figures Figure 1 Introduction Overcrowding in both adult and pediatric emergency departments (EDs and PEDs, respectively) is a well-documented and persistent issue that presents significant challenges to healthcare delivery ( 1 – 2 ). The increasing demand for emergency services frequently exceeds available resources, resulting in prolonged wait times, diminished patient satisfaction, and potential compromises in the quality of care ( 1 ). Notably, infants and young children exhibit the highest rate of hospital admission due to infectious diseases, followed by patients over the age of 75, particularly during the pandemic season ( 1 – 2 ). Various strategies have been proposed and implemented to address the misuse of resources, including process improvements, point-of-care tests, policy reforms, and healthcare education ( 2 – 3 ). Nevertheless, these measures have often failed to achieve the desired outcomes, leaving PED overcrowding and misuse as critical concerns within healthcare systems globally ( 2 – 3 ). Fever is a prevalent reason for visits to pediatric emergency departments (PEDs), accounting for approximately 20–30% of cases, with admissions increasing during seasonal peaks of viral infections ( 4 – 8 ). The majority of respiratory illnesses are viral in nature, with Influenza, Parainfluenza, Respiratory Syncytial Virus, and Adenovirus being the most common pathogens. However, symptoms are often non-specific, rendering clinical diagnosis of the causative agent unreliable and necessitating extensive diagnostic investigations ( 5 – 7 , 9 ). Consequently, accurate diagnosis of respiratory infections has relied on molecular methods, specifically multiplex Real-Time Polymerase Chain Reaction (RT-PCR) panel testing ( 5 , 9 – 10 ). While multiplex RT-PCR provides precise diagnoses, it has traditionally been conducted in central laboratories, resulting in a prolonged test turnaround time (TAT) and significant impacts on emergency department workflows and care processes ( 3 , 5 , 10 ). Therefore, delays in laboratory test results are frequently considered one of the factors contributing to overcrowding in emergency departments and pediatric emergency departments, as well as prolonged length of stay (LOS) ( 4 ). In recent years, there has been a growing interest in enhancing and expediting the diagnosis of viral illnesses, with the implementation of rapid diagnostic tests (RDTs) emerging as a promising strategy to improve patient management in both EDs and PEDs ( 5 – 6 , 9 – 13 ). Despite the theoretical benefits, the impact of RDTs on operational metrics, such as PED length of stay (LOS), and their potential to mitigate overcrowding remain subjects of ongoing research. The objective of the present study was to evaluate whether early etiological diagnosis of febrile pediatric patients presenting with respiratory symptoms, facilitated by RDTs for adenovirus and influenza, could reduce the average waiting time in PEDs. By potentially decreasing LOS, this approach may offer a partial solution to the challenges of PED overcrowding and misuse. Materials and Methods We conducted a retrospective cohort study at PED of the IRCCS Istituto Giannina Gaslini, analyzing data from pediatric patients who presented to the PED during the last two epidemic seasons (2023-2024, 2024-2025), defined as the period from the first day of December to the last day of February. The IRCCS Istituto Giannina Gaslini is a tertiary care children's hospital serving the Liguria region in northwestern Italy, with an average of 38,000 PED visits annually from patients aged 0–18 years. All retrospective data were collected from anonymized electronic medical records. The inclusion criteria encompassed all patients who underwent RDT for adenovirus and/or influenza due to febrile illness accompanied by respiratory symptoms. The decision to perform rapid antigen testing was based on clinical judgment in accordance with institutional protocols. All tests were conducted using the Standard F antigen Point-of-Care produced by Relab, SD Biosensor TM . The sensitivity and specificity for influenza were 97.0% and 97.6%, respectively, while those for adenovirus were 83.3% and 95.5%, respectively (6). Tests have a (TAT of 10 to 15 minutes and were performed on demand at the bedside, eliminating the need for transport to a laboratory. The point-of-care test requires no specific expertise and can be performed by healthcare personnel following a brief demonstration. The data collected included patient demographics (age, sex), test results, (LOS in the PED measured in minutes from triage to discharge (TTD) and from the physician's acceptance to discharge (ATD), and return visits to the PED within 72 hours post-discharge. All RDTs for adenovirus and influenza were recorded. Patients were categorized into two groups: those with at least one positive test and those with single or double negativity. Tests for a single etiological agent were subsequently considered and divided into positive and negative tests. Patients subjected to both tests, who tested positive for one of the two, were enrolled only in the group with a positive RDT, whereas patients with double negativity were considered in both etiological groups as negative subjects. Figure 1 summarizes and schematizes the recruitment and grouping method. The PED LOSs were compared between the two groups in terms of TTD and ATD waiting times. Additionally, the two LOS times were compared among patients with at least one positive RDT. Statistical Analysis Categorical variables are reported as absolute frequencies and percentages, while continuous variables are presented as medians and interquartile ranges. To evaluate differences between groups, the Kruskal-Wallis test or Mann–Whitney U-test was employed for continuous variables, and the chi-square or Fisher's exact test was utilized for categorical variables. Statistical significance was established at p < 0.05, with all values determined using two-tailed tests. All statistical analyses were performed using GraphPad Prism version 9.1.0 for Windows (GraphPad Software, San Diego, California, USA, www.graphpad.com) or IBM SPSS Statistics for Windows Version 21.0 (IBM Corp. Armonk, NY, USA). Results During the study period, 1,238 patients met the inclusion criteria, representing 6.5% of the total 19,328 patients assessed at our Pediatric Emergency Department (PED). Among these, 330 patients (26.6%) tested positive for either adenovirus or influenza, while 908 patients (73.4%) tested negative. A total of 332 patients were tested for both viruses. The median age of the cohort was 3.3 years (interquartile range: 1.4–7.2 years), with a slight male predominance (58.1%). No significant differences in gender or age were observed between the two groups. The LOS in the PED differed significantly between the two groups. Patients with at least one positive RDT had a median TTD of 217.0 minutes (125.0-295.5), whereas those with negative tests had a median TTD of 239.0 minutes (157.0-335.0). This difference was statistically significant (p < 0.001), and the same was observed when considering the ADT (p < 0.001). The main data are presented in Table 1 . Table 1 Demographic and clinical characteristics of tested patients. Total patients n = 1238 Positive patients n = 330 Negative patients n = 908 p Age in years, median (IQR) 3.3 (1.4–7.2) 3.6 (1.8–6.8) 3.2 (1.3–7.5) 0.20 Sex, male (%) 722 (58.1) 192 (58.2) 530 (58.4) 0.95 TTD in minutes, median (IQR) 232.5 (147.0-324.0) 217.0 (125.0-295.5) 239.0 (157.0-335.0) < 0.001 ATD in minutes, median (IQR) 132.0 (60.0-215.0) 66.0 (37.0-154.5) 148.5 (84.0-227.0) < 0.001 Readmission, yes (%) 58 (4.7) 14 (4.2) 44 (4.8) 0.65 Abbreviations : TTD: triage-to-discharge time; ATD: admission-to-discharge time; IQR: interquartile range; RDT: rapid diagnostic test. These findings are further corroborated by the individual analysis of patients subjected to RDTs for influenza and adenovirus, both for TTD and ADT (Tables 2 and 3 ). Additionally, no increased rate of readmission within 72 hours post-discharge was observed in patients with a positive RDT across any of the populations examined. Table 2 Clinical characteristics of patients tested for Influenza A/B. Total Flu A/B patients n = 908 Positive patients n = 263 Negative patients n = 645 p Age in years, median (IQR) 3.6 (1.4–7.7) 4.0 (2.0-7.6) 3.2 (1.7–7.9) 0.18 Sex, male (%) 527 (58.0) 148 (56.2) 379 (58.7) 0.49 TTD in minutes, median (IQR) 229.5 (144.0-323.0) 220.0 (125.0-297.0) 235.0 (149.0-334.0) 0.006 ATD in minutes, median (IQR) 126.0 (56.0-206.0) 64.0 (36.0-150.0) 144.0 (82.0-225.5) < 0.001 Readmission, yes (%) 39 (4.3) 13 (4.9) 26 (4.0) 0.53 Abbreviations : TTD: triage-to-discharge time; ATD: admission-to-discharge time; IQR: interquartile range; RDT: rapid diagnostic test. Table 3 Clinical characteristics of patients tested for Adenovirus. Total Adenovirus patients n = 604 Positive patients n = 67 Negative patients n = 537 p Age in years, median (IQR) 2.8 (1.2–6.3) 2.2 (1.3–4.9) 2.9 (1.2–6.9) 0.09 Sex, male (%) 353 (58.4) 44 (65.1) 309 (57.5) 0.20 TTD in minutes, median (IQR) 251.5 (169.0-346.5) 215.0 (132.5–281.0) 257.0 (178.0-352.0) 0.001 ATD in minutes, median (IQR) 154.5 (88.0-242.0) 77.0 (45.5–175.0) 163.0 (100.0-249.0) < 0.001 Readmission, yes (%) 28 (4.6) 1 (1.5) 27 (5.0) 0.19 Abbreviations : TTD: triage-to-discharge time; ATD: admission-to-discharge time; IQR: interquartile range; RDT: rapid diagnostic test. Finally, a statistically significant difference was identified between TTD and ADT in patients with positive results, both overall and by specific etiology (Table 4 ). Table 4 Comparison of TTD and ATD times among positive patients TTD in minutes, median (IQR) ATD in minutes, median (IQR) p Total positive patients n = 330 217.0 (125.0-295.5) 66.0 (37.0-154.5) < 0.001 Flu A/B positive patients n = 263 220.0 (125.0-297.0) 64.0 (136.0-150.0) < 0.001 Adenovirus positive patients n = 67 215.0 (132.5–281.0) 77.0 (45.5–175.0) < 0.001 Abbreviations : TTD: triage-to-discharge time; ATD: admission-to-discharge time; IQR: interquartile range; RDT: rapid diagnostic test. Discussion ED overcrowding and misuse represent intricate, multifactorial challenges that cannot be addressed solely by those responsible for managing and delivering care within EDs. Effective solutions necessitate coordinated efforts across healthcare delivery systems. Our study, however, has demonstrated that the implementation of RDTs for adenovirus and influenza in febrile pediatric patients presenting with respiratory symptoms is associated with a statistically significant reduction PED LOS, offering a partial solution to the overcrowding issue. This finding is consistent with previous research, which suggests that rapid diagnostic testing can expedite clinical decision-making and patient disposition in pediatric emergency settings ( 4 – 5 , 10 , 12 ). With an analysis time of approximately 15 minutes and a sensitivity exceeding 85% for both viruses, as recommended by the World Health Organization for rapid tests, RDTs in PEDs are linked to a significant decrease in hospital admissions, shorter TAT, and reduced hospital resource utilization ( 4 – 6 , 9 – 10 , 14 ). Consequently, RDTs for adenovirus and influenza A/B in the PED setting may facilitate early diagnosis and safe discharge ( 6 ). However, while there is consensus regarding their efficacy in pediatric populations, conflicting data persist in adult emergency departments ( 5 – 6 , 11 , 13 , 15 – 17 ). As a result, the LOS in adult EDs may not consistently be reduced, and RDTs for respiratory viruses should be considered differently when comparing adult and pediatric patients ( 13 ). These discrepancies can be partially attributed to the fact that, while RDTs enable early diagnosis in children without further assessment, in elderly patients or those with cancer or comorbidities, a positive RDT may indicate a heightened risk of clinical deterioration, necessitating increased hospitalization and targeted therapies ( 5 – 6 , 8 , 11 , 16 – 17 ). Seasonal influenza often reaches its peak, contributing significantly to overcrowding in both EDs and PEDs ( 7 , 11 , 15 ). Consequently, the implementation of an influenza RDT may reduce the LOS in EDs and facilitate a more efficient distribution of patient flow within the department ( 5 , 11 ). It has been proposed to conduct this test during triage as part of a "see and treat" process, which has been widely recommended as a partial solution to ED overcrowding ( 1 ). In adult EDs, where the efficacy of RDTs in reducing LOS is debated, this practice appears to have significantly decreased LOS without increasing the rate of bounce-back admissions ( 8 , 13 , 15 ). This finding is particularly noteworthy, as analysis of the TTD and ATD in positive patient groups revealed a statistically significant difference, indicating that RDTs conducted early in triage could enhance patient flow in PEDs. These findings are further corroborated by lessons learned from the SARS-CoV-2 pandemic in recent years. Early and rapid virus detection is crucial in healthcare settings to implement appropriate infection control measures and promptly assign patients to suitable care pathways, particularly among vulnerable groups such as the elderly, infants, and individuals with comorbidities ( 13 , 18 ). These findings, along with our evidence, suggest that the judicious use of RDTs can facilitate both expedited and more appropriate clinical and therapeutic decisions. The observed reduction in LOS in our study may be attributed to several factors. Firstly, the rapid identification of viral etiologies likely enabled more targeted management decisions, such as the initiation of antiviral therapy when appropriate or the avoidance of unnecessary antibiotic use ( 8 – 11 ). Secondly, early diagnosis may have allowed healthcare providers to implement timely infection control measures, thereby reducing the need for prolonged isolation and monitoring within PEDs ( 8 , 10 – 11 ). Collectively, these factors contribute to more efficient patient throughput, which is critical in addressing the challenges of PED overcrowding. Moreover, conducting RDTs directly in triage could yield several positive outcomes, including cohort isolation of non-urgent, positive patients awaiting consultation, early diagnosis and discharge with increased parental satisfaction, and improved resource allocation, allowing ED rooms and staff physicians to focus on higher-acuity patients ( 1 – 5 , 9 , 11 , 17 ). While data regarding the impact of influenza RDTs on PED patient flow have been previously documented, this study represents, to our knowledge, the first to individually analyze patients tested for adenovirus. Although adenovirus is less prevalent than influenza, it can occur throughout the year without predictable seasonality, unlike influenza, and can cause severe illness in children by mimicking bacterial infections or inflammatory diseases ( 6 ). Consequently, it is crucial to consider all potential viral etiologies to enhance the accuracy of etiological diagnoses and expedite clinical therapeutic decision-making. Notably, our analysis demonstrated that the rate of return visits within 72 hours was comparable between patients with positive and negative rapid antigen test results. This finding suggests that the utilization of rapid testing does not compromise patient safety or result in premature discharge. Previous studies have reported similar outcomes, indicating that rapid diagnostic testing does not increase the likelihood of adverse events or return visits ( 5 ). Furthermore, it has been observed that in young children aged three to 36 months, the prevalence of bacterial infection is lower in febrile patients who test positive for viral infection ( 5 ). While our study provides evidence supporting the utility of RDTs in reducing PED LOS, it is imperative to consider the broader implications of PED overcrowding. Overcrowding is a complex issue influenced by factors such as patient inflow, hospital capacity, and systemic healthcare dynamics. Therefore, although RDTs can contribute to improved patient flow, they should be integrated as part of a comprehensive strategy that includes resource optimization, process improvements, and policy interventions. Limitations We did not consider the waiting times of patients awaiting admission, as in this context, the LOS in the PED is influenced not only by the efficiency of diagnosis and decision-making but also by the capacity of the departments to accept patients. Furthermore, although we considered two of the most prevalent viruses, numerous other viruses, such as parainfluenza, bocavirus, and metapneumovirus, have not been tested and, to our knowledge, do not yet have dedicated RDTs. Lastly, we lacked data on viral-bacterial coinfection. Conclusion Early etiological diagnosis of febrile pediatric patients presenting with respiratory symptoms through the use of RDTs for adenovirus and influenza is correlated with a significant reduction in PED LOS, without an associated increase in the risk of return visits. These findings advocate for the utilization of RDTs in patients with acute respiratory illnesses and suggest that they may offer a partial solution to the challenges of PED overcrowding and misuse. Further clinical trials and the implementation of RDTs for additional viruses are necessary to evaluate the role of rapid diagnostic technologies in managing patient flow within PEDs. Abbreviations ATD Acceptance-to-discharge time ED Emergency Department LOS Length of Stay PED Pediatric Emergency Department RDT Rapid Diagnostic Test RT-PCR Real-Time Polymerase Chain Reaction SARS-CoV-2 Severe Acute Respiratory Syndrome CoronaVirus 2 TAT Turnaround Time TTD Triage-to-discharge time Declarations Ethics approval and consent to participate: this study was conducted in accordance with the principles of the Declaration of Helsinki. This retrospective study was conducted using anonymized data collected for routine clinical care. Our local Ethical Committee reviewed the study protocol and determined that formal ethical approval was not required. The study was reviewed by the Comitato Etico Territoriale - Liguria (CET Liguria), established by the Regional Government Resolution No. 478 dated May 26, 2023, and operational since January 1, 2024, under the administration of A.Li.Sa. (Azienda Ligure Sanitaria), Genoa, Italy. As the study was retrospective and based on anonymized data, the requirement for informed consent was waived by the local Ethical Committee. Availability of data and materials: the datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Funding: the article processing charge (APC) was supported by Relab, SD Biosensor TM . The company had no role in the study design, data collection, data analysis, data interpretation, writing of the manuscript, or the decision to submit for publication. Conflict of Interest: the authors declare no competing interests. Clinical trial number: not applicable Authors' contributions : Conceptualization, TB, GI, MV, MM; Data curation, GI, MV, BV, SM, FC, CP; Formal analysis, TB, MM; Supervision, BT, EP, AM; Visualization, TB, SM, FC, CP; Writing – original draft, TB, GI, MV; Writing – review & editing, BT, EP, AM. All authors read and approved the final manuscript. 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PMID: 25375835; PMCID: PMC4222913. Bond KA, Smith B, Gardiner E, Liew KC, Williams E, Walsham N, et sl. Utility of SARS-CoV-2 rapidantigentesting for patient triage in the emergencydepartment: A clinicalimplementationstudy in Melbourne, Australia. Lancet Reg Health West Pac. 2022 May30;25:100486. doi: 10.1016/j.lanwpc.2022.100486. PMID: 35655473; PMCID: PMC9150863. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6546327","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":475702694,"identity":"a41dc4af-2453-4940-a853-187f43ef654b","order_by":0,"name":"Tommaso Bellini","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYBCDBAZ25oYDDAY2QDaYgVspD1wLMyNIZRqQzUiCFiB9GKwFr4Ps2btTN/z4Y5PHz8zYeLig4Lxdf/9BEINBzrx/AXZbeM5uu9nbllYs2czYcHiGwe3kGTcSQQwGY5kbD7BrkcjddoO34XDihsNALTxALQw3wAyGxBkSB3Bqufnnz+HE/RAt55Llzx8krOU2DxvQFmawlgN2BgcSoVr4sQcDz5mz227LAv0iAbElOcHwBliLhLGEBPYQY2/v3XbzDSjE2psPf+b5Y2cvd/4wiGEjJ8GP3WEYIBHqGqAVEgnEabFHMIm1ZRSMglEwCoY7AACWamdYC3wodAAAAABJRU5ErkJggg==","orcid":"","institution":"IRCCS Istituto Giannina Gaslini","correspondingAuthor":true,"prefix":"","firstName":"Tommaso","middleName":"","lastName":"Bellini","suffix":""},{"id":475702695,"identity":"aaa2d42e-0dd1-490e-9356-4b8c7c52d3aa","order_by":1,"name":"Giorgia Iovinella","email":"","orcid":"","institution":"University of Genoa","correspondingAuthor":false,"prefix":"","firstName":"Giorgia","middleName":"","lastName":"Iovinella","suffix":""},{"id":475702696,"identity":"fccd4d08-fb3e-4b88-b5c5-66b87ed07b3b","order_by":2,"name":"Martina Virgilio","email":"","orcid":"","institution":"University of Genoa","correspondingAuthor":false,"prefix":"","firstName":"Martina","middleName":"","lastName":"Virgilio","suffix":""},{"id":475702697,"identity":"2a6069da-531b-4e54-9838-de1ca298a6da","order_by":3,"name":"Marcello Mariani","email":"","orcid":"","institution":"IRCCS Istituto Giannina Gaslini","correspondingAuthor":false,"prefix":"","firstName":"Marcello","middleName":"","lastName":"Mariani","suffix":""},{"id":475702698,"identity":"2143d4bc-34f3-476c-8d4d-2b4190a7e84c","order_by":4,"name":"Simona Matarese","email":"","orcid":"","institution":"IRCCS Istituto Giannina Gaslini","correspondingAuthor":false,"prefix":"","firstName":"Simona","middleName":"","lastName":"Matarese","suffix":""},{"id":475702699,"identity":"3d1cdeb6-47ff-473c-8eca-d9b170e7114e","order_by":5,"name":"Francesca Canzoneri","email":"","orcid":"","institution":"IRCCS Istituto Giannina Gaslini","correspondingAuthor":false,"prefix":"","firstName":"Francesca","middleName":"","lastName":"Canzoneri","suffix":""},{"id":475702700,"identity":"43e00cb6-2d26-4a8e-ab1b-9d10c01c2449","order_by":6,"name":"Carlotta Pepino","email":"","orcid":"","institution":"IRCCS Istituto Giannina Gaslini","correspondingAuthor":false,"prefix":"","firstName":"Carlotta","middleName":"","lastName":"Pepino","suffix":""},{"id":475702701,"identity":"465c318b-8930-4e4b-a45d-766f6ea8a2ac","order_by":7,"name":"Barbara Vanorio","email":"","orcid":"","institution":"University of Genoa","correspondingAuthor":false,"prefix":"","firstName":"Barbara","middleName":"","lastName":"Vanorio","suffix":""},{"id":475702702,"identity":"b92a4e94-5b74-4f40-b155-01e6c8e2ad97","order_by":8,"name":"Barbara Tubino","email":"","orcid":"","institution":"IRCCS Istituto Giannina Gaslini","correspondingAuthor":false,"prefix":"","firstName":"Barbara","middleName":"","lastName":"Tubino","suffix":""},{"id":475702703,"identity":"4adb1599-3954-454b-9f24-aa228d0bc13e","order_by":9,"name":"Emanuela Piccotti","email":"","orcid":"","institution":"IRCCS Istituto Giannina Gaslini","correspondingAuthor":false,"prefix":"","firstName":"Emanuela","middleName":"","lastName":"Piccotti","suffix":""},{"id":475702704,"identity":"0aa84577-4605-44b2-930a-63cdac8fec98","order_by":10,"name":"Andrea Moscatelli","email":"","orcid":"","institution":"IRCCS Istituto Giannina Gaslini","correspondingAuthor":false,"prefix":"","firstName":"Andrea","middleName":"","lastName":"Moscatelli","suffix":""}],"badges":[],"createdAt":"2025-04-28 09:38:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6546327/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6546327/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85724139,"identity":"4b1edc9f-9a71-4596-872f-130136d9cbef","added_by":"auto","created_at":"2025-07-01 06:14:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":884418,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of patient selection and test results during the study period. Out of 19,328 patients admitted to the PED, 1,238 underwent RDTs for Influenza A/B and/or Adenovirus, with a total of 1,560 tests performed. Of these, 330 patients tested positive: 263 for Influenza A/B (30 of whom were negative for Adenovirus) and 67 for Adenovirus (18 of whom were negative for Influenza A/B). Among 908 patients with negative results, 274 were tested for both viruses and were negative for both. The number of negative RDTs for each virus is also detailed. \u003cem\u003eAbbreviations\u003c/em\u003e\u003cem\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/em\u003e\u003cem\u003ePED: pediatric emergency department; RDT: rapid diagnostic test.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6546327/v1/a6be1af87eca364c42a3942f.png"},{"id":101754358,"identity":"7855d197-fb9d-40e9-8ea9-740776703ec6","added_by":"auto","created_at":"2026-02-03 10:42:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1383794,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6546327/v1/93340693-4a50-41cc-8423-980e2a5a18c1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association Between Rapid Viral Testing and Reduced Length of Stay in a Pediatric Emergency Department During Epidemic Seasons: Implications for Overcrowding Management","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOvercrowding in both adult and pediatric emergency departments (EDs and PEDs, respectively) is a well-documented and persistent issue that presents significant challenges to healthcare delivery (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The increasing demand for emergency services frequently exceeds available resources, resulting in prolonged wait times, diminished patient satisfaction, and potential compromises in the quality of care (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Notably, infants and young children exhibit the highest rate of hospital admission due to infectious diseases, followed by patients over the age of 75, particularly during the pandemic season (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Various strategies have been proposed and implemented to address the misuse of resources, including process improvements, point-of-care tests, policy reforms, and healthcare education (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Nevertheless, these measures have often failed to achieve the desired outcomes, leaving PED overcrowding and misuse as critical concerns within healthcare systems globally (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFever is a prevalent reason for visits to pediatric emergency departments (PEDs), accounting for approximately 20\u0026ndash;30% of cases, with admissions increasing during seasonal peaks of viral infections (\u003cspan additionalcitationids=\"CR5 CR6 CR7\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The majority of respiratory illnesses are viral in nature, with Influenza, Parainfluenza, Respiratory Syncytial Virus, and Adenovirus being the most common pathogens. However, symptoms are often non-specific, rendering clinical diagnosis of the causative agent unreliable and necessitating extensive diagnostic investigations (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Consequently, accurate diagnosis of respiratory infections has relied on molecular methods, specifically multiplex Real-Time Polymerase Chain Reaction (RT-PCR) panel testing (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). While multiplex RT-PCR provides precise diagnoses, it has traditionally been conducted in central laboratories, resulting in a prolonged test turnaround time (TAT) and significant impacts on emergency department workflows and care processes (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Therefore, delays in laboratory test results are frequently considered one of the factors contributing to overcrowding in emergency departments and pediatric emergency departments, as well as prolonged length of stay (LOS) (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn recent years, there has been a growing interest in enhancing and expediting the diagnosis of viral illnesses, with the implementation of rapid diagnostic tests (RDTs) emerging as a promising strategy to improve patient management in both EDs and PEDs (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10 CR11 CR12\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Despite the theoretical benefits, the impact of RDTs on operational metrics, such as PED length of stay (LOS), and their potential to mitigate overcrowding remain subjects of ongoing research. The objective of the present study was to evaluate whether early etiological diagnosis of febrile pediatric patients presenting with respiratory symptoms, facilitated by RDTs for adenovirus and influenza, could reduce the average waiting time in PEDs. By potentially decreasing LOS, this approach may offer a partial solution to the challenges of PED overcrowding and misuse.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eWe conducted a retrospective cohort study at PED of the IRCCS Istituto Giannina Gaslini, analyzing data from pediatric patients who presented to the PED during the last two epidemic seasons (2023-2024, 2024-2025), defined as the period from the first day of December to the last day of February. The IRCCS Istituto Giannina Gaslini is a tertiary care children's hospital serving the Liguria region in northwestern Italy, with an average of 38,000 PED visits annually from patients aged 0–18 years. All retrospective data were collected from anonymized electronic medical records.\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria encompassed all patients who underwent RDT for adenovirus and/or influenza due to febrile illness accompanied by respiratory symptoms. The decision to perform rapid antigen testing was based on clinical judgment in accordance with institutional protocols. All tests were conducted using the Standard F antigen Point-of-Care produced by Relab, SD Biosensor\u003csup\u003eTM\u003c/sup\u003e. The sensitivity and specificity for influenza were 97.0% and 97.6%, respectively, while those for adenovirus were 83.3% and 95.5%, respectively (6). Tests have a (TAT of 10 to 15 minutes and were performed on demand at the bedside, eliminating the need for transport to a laboratory. The point-of-care test requires no specific expertise and can be performed by healthcare personnel following a brief demonstration.\u003c/p\u003e\n\u003cp\u003eThe data collected included patient demographics (age, sex), test results, (LOS in the PED measured in minutes from triage to discharge (TTD) and from the physician's acceptance to discharge (ATD), and return visits to the PED within 72 hours post-discharge.\u003c/p\u003e\n\u003cp\u003eAll RDTs for adenovirus and influenza were recorded. Patients were categorized into two groups: those with at least one positive test and those with single or double negativity. Tests for a single etiological agent were subsequently considered and divided into positive and negative tests. Patients subjected to both tests, who tested positive for one of the two, were enrolled only in the group with a positive RDT, whereas patients with double negativity were considered in both etiological groups as negative subjects. Figure 1 summarizes and schematizes the recruitment and grouping method.\u003c/p\u003e\n\u003cp\u003eThe PED LOSs were compared between the two groups in terms of TTD and ATD waiting times. Additionally, the two LOS times were compared among patients with at least one positive RDT.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical Analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eCategorical variables are reported as absolute frequencies and percentages, while continuous variables are presented as medians and interquartile ranges. To evaluate differences between groups, the Kruskal-Wallis test or Mann–Whitney U-test was employed for continuous variables, and the chi-square or Fisher's exact test was utilized for categorical variables. Statistical significance was established at p \u0026lt; 0.05, with all values determined using two-tailed tests. All statistical analyses were performed using GraphPad Prism version 9.1.0 for Windows (GraphPad Software, San Diego, California, USA, www.graphpad.com) or IBM SPSS Statistics for Windows Version 21.0 (IBM Corp. Armonk, NY, USA).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDuring the study period, 1,238 patients met the inclusion criteria, representing 6.5% of the total 19,328 patients assessed at our Pediatric Emergency Department (PED). Among these, 330 patients (26.6%) tested positive for either adenovirus or influenza, while 908 patients (73.4%) tested negative. A total of 332 patients were tested for both viruses. The median age of the cohort was 3.3 years (interquartile range: 1.4\u0026ndash;7.2 years), with a slight male predominance (58.1%). No significant differences in gender or age were observed between the two groups.\u003c/p\u003e \u003cp\u003eThe LOS in the PED differed significantly between the two groups. Patients with at least one positive RDT had a median TTD of 217.0 minutes (125.0-295.5), whereas those with negative tests had a median TTD of 239.0 minutes (157.0-335.0). This difference was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the same was observed when considering the ADT (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The main data are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and clinical characteristics of tested patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal patients\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;1238\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePositive patients\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;330\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNegative patients\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;908\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge in years,\u003c/p\u003e \u003cp\u003e\u003cem\u003emedian (IQR)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.3 (1.4\u0026ndash;7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.6 (1.8\u0026ndash;6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.2 (1.3\u0026ndash;7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, \u003cem\u003emale (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e722 (58.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e192 (58.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e530 (58.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTTD in minutes,\u003c/p\u003e \u003cp\u003e\u003cem\u003emedian (IQR)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e232.5 (147.0-324.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e217.0 (125.0-295.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e239.0 (157.0-335.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eATD in minutes,\u003c/p\u003e \u003cp\u003e\u003cem\u003emedian (IQR)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e132.0 (60.0-215.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.0 (37.0-154.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e148.5 (84.0-227.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReadmission, \u003cem\u003eyes (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eAbbreviations\u003c/b\u003e: \u003cem\u003eTTD: triage-to-discharge time; ATD: admission-to-discharge time; IQR: interquartile range; RDT: rapid diagnostic test.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThese findings are further corroborated by the individual analysis of patients subjected to RDTs for influenza and adenovirus, both for TTD and ADT (Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Additionally, no increased rate of readmission within 72 hours post-discharge was observed in patients with a positive RDT across any of the populations examined.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics of patients tested for Influenza A/B.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal Flu A/B patients\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;908\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePositive patients\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;263\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNegative patients\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;645\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge in years,\u003c/p\u003e \u003cp\u003e\u003cem\u003emedian (IQR)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.6 (1.4\u0026ndash;7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.0 (2.0-7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.2 (1.7\u0026ndash;7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, \u003cem\u003emale (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e527 (58.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e148 (56.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e379 (58.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTTD in minutes,\u003c/p\u003e \u003cp\u003e\u003cem\u003emedian (IQR)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e229.5 (144.0-323.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e220.0 (125.0-297.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e235.0 (149.0-334.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eATD in minutes,\u003c/p\u003e \u003cp\u003e\u003cem\u003emedian (IQR)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e126.0 (56.0-206.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.0 (36.0-150.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e144.0 (82.0-225.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReadmission, \u003cem\u003eyes (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eAbbreviations\u003c/b\u003e: \u003cem\u003eTTD: triage-to-discharge time; ATD: admission-to-discharge time; IQR: interquartile range; RDT: rapid diagnostic test.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics of patients tested for Adenovirus.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal Adenovirus patients\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;604\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePositive patients\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;67\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNegative patients\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;537\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge in years,\u003c/p\u003e \u003cp\u003e\u003cem\u003emedian (IQR)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.8 (1.2\u0026ndash;6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.2 (1.3\u0026ndash;4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.9 (1.2\u0026ndash;6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, \u003cem\u003emale (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e353 (58.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44 (65.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e309 (57.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTTD in minutes,\u003c/p\u003e \u003cp\u003e\u003cem\u003emedian (IQR)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e251.5 (169.0-346.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e215.0 (132.5\u0026ndash;281.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e257.0 (178.0-352.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eATD in minutes,\u003c/p\u003e \u003cp\u003e\u003cem\u003emedian (IQR)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e154.5 (88.0-242.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77.0 (45.5\u0026ndash;175.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e163.0 (100.0-249.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReadmission, \u003cem\u003eyes (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eAbbreviations\u003c/b\u003e: \u003cem\u003eTTD: triage-to-discharge time; ATD: admission-to-discharge time; IQR: interquartile range; RDT: rapid diagnostic test.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFinally, a statistically significant difference was identified between TTD and ADT in patients with positive results, both overall and by specific etiology (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of TTD and ATD times among positive patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTTD in minutes,\u003c/p\u003e \u003cp\u003e\u003cem\u003emedian (IQR)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eATD in minutes,\u003c/p\u003e \u003cp\u003e\u003cem\u003emedian (IQR)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal positive patients\u003c/b\u003e\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;330\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e217.0 (125.0-295.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.0 (37.0-154.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFlu A/B positive patients\u003c/b\u003e\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e220.0 (125.0-297.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.0 (136.0-150.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdenovirus positive patients\u003c/b\u003e\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e215.0 (132.5\u0026ndash;281.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.0 (45.5\u0026ndash;175.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003eAbbreviations\u003c/b\u003e: \u003cem\u003eTTD: triage-to-discharge time; ATD: admission-to-discharge time; IQR: interquartile range; RDT: rapid diagnostic test.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eED overcrowding and misuse represent intricate, multifactorial challenges that cannot be addressed solely by those responsible for managing and delivering care within EDs. Effective solutions necessitate coordinated efforts across healthcare delivery systems. Our study, however, has demonstrated that the implementation of RDTs for adenovirus and influenza in febrile pediatric patients presenting with respiratory symptoms is associated with a statistically significant reduction PED LOS, offering a partial solution to the overcrowding issue. This finding is consistent with previous research, which suggests that rapid diagnostic testing can expedite clinical decision-making and patient disposition in pediatric emergency settings (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). With an analysis time of approximately 15 minutes and a sensitivity exceeding 85% for both viruses, as recommended by the World Health Organization for rapid tests, RDTs in PEDs are linked to a significant decrease in hospital admissions, shorter TAT, and reduced hospital resource utilization (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Consequently, RDTs for adenovirus and influenza A/B in the PED setting may facilitate early diagnosis and safe discharge (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, while there is consensus regarding their efficacy in pediatric populations, conflicting data persist in adult emergency departments (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). As a result, the LOS in adult EDs may not consistently be reduced, and RDTs for respiratory viruses should be considered differently when comparing adult and pediatric patients (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). These discrepancies can be partially attributed to the fact that, while RDTs enable early diagnosis in children without further assessment, in elderly patients or those with cancer or comorbidities, a positive RDT may indicate a heightened risk of clinical deterioration, necessitating increased hospitalization and targeted therapies (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSeasonal influenza often reaches its peak, contributing significantly to overcrowding in both EDs and PEDs (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Consequently, the implementation of an influenza RDT may reduce the LOS in EDs and facilitate a more efficient distribution of patient flow within the department (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). It has been proposed to conduct this test during triage as part of a \"see and treat\" process, which has been widely recommended as a partial solution to ED overcrowding (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In adult EDs, where the efficacy of RDTs in reducing LOS is debated, this practice appears to have significantly decreased LOS without increasing the rate of bounce-back admissions (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). This finding is particularly noteworthy, as analysis of the TTD and ATD in positive patient groups revealed a statistically significant difference, indicating that RDTs conducted early in triage could enhance patient flow in PEDs.\u003c/p\u003e \u003cp\u003eThese findings are further corroborated by lessons learned from the SARS-CoV-2 pandemic in recent years. Early and rapid virus detection is crucial in healthcare settings to implement appropriate infection control measures and promptly assign patients to suitable care pathways, particularly among vulnerable groups such as the elderly, infants, and individuals with comorbidities (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). These findings, along with our evidence, suggest that the judicious use of RDTs can facilitate both expedited and more appropriate clinical and therapeutic decisions.\u003c/p\u003e \u003cp\u003eThe observed reduction in LOS in our study may be attributed to several factors. Firstly, the rapid identification of viral etiologies likely enabled more targeted management decisions, such as the initiation of antiviral therapy when appropriate or the avoidance of unnecessary antibiotic use (\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Secondly, early diagnosis may have allowed healthcare providers to implement timely infection control measures, thereby reducing the need for prolonged isolation and monitoring within PEDs (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Collectively, these factors contribute to more efficient patient throughput, which is critical in addressing the challenges of PED overcrowding. Moreover, conducting RDTs directly in triage could yield several positive outcomes, including cohort isolation of non-urgent, positive patients awaiting consultation, early diagnosis and discharge with increased parental satisfaction, and improved resource allocation, allowing ED rooms and staff physicians to focus on higher-acuity patients (\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile data regarding the impact of influenza RDTs on PED patient flow have been previously documented, this study represents, to our knowledge, the first to individually analyze patients tested for adenovirus. Although adenovirus is less prevalent than influenza, it can occur throughout the year without predictable seasonality, unlike influenza, and can cause severe illness in children by mimicking bacterial infections or inflammatory diseases (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Consequently, it is crucial to consider all potential viral etiologies to enhance the accuracy of etiological diagnoses and expedite clinical therapeutic decision-making.\u003c/p\u003e \u003cp\u003eNotably, our analysis demonstrated that the rate of return visits within 72 hours was comparable between patients with positive and negative rapid antigen test results. This finding suggests that the utilization of rapid testing does not compromise patient safety or result in premature discharge. Previous studies have reported similar outcomes, indicating that rapid diagnostic testing does not increase the likelihood of adverse events or return visits (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Furthermore, it has been observed that in young children aged three to 36 months, the prevalence of bacterial infection is lower in febrile patients who test positive for viral infection (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile our study provides evidence supporting the utility of RDTs in reducing PED LOS, it is imperative to consider the broader implications of PED overcrowding. Overcrowding is a complex issue influenced by factors such as patient inflow, hospital capacity, and systemic healthcare dynamics. Therefore, although RDTs can contribute to improved patient flow, they should be integrated as part of a comprehensive strategy that includes resource optimization, process improvements, and policy interventions.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eWe did not consider the waiting times of patients awaiting admission, as in this context, the LOS in the PED is influenced not only by the efficiency of diagnosis and decision-making but also by the capacity of the departments to accept patients. Furthermore, although we considered two of the most prevalent viruses, numerous other viruses, such as parainfluenza, bocavirus, and metapneumovirus, have not been tested and, to our knowledge, do not yet have dedicated RDTs. Lastly, we lacked data on viral-bacterial coinfection.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eEarly etiological diagnosis of febrile pediatric patients presenting with respiratory symptoms through the use of RDTs for adenovirus and influenza is correlated with a significant reduction in PED LOS, without an associated increase in the risk of return visits. These findings advocate for the utilization of RDTs in patients with acute respiratory illnesses and suggest that they may offer a partial solution to the challenges of PED overcrowding and misuse. Further clinical trials and the implementation of RDTs for additional viruses are necessary to evaluate the role of rapid diagnostic technologies in managing patient flow within PEDs.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eATD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Acceptance-to-discharge time\u003c/p\u003e\n\u003cp\u003eED\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Emergency Department\u003c/p\u003e\n\u003cp\u003eLOS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Length of Stay\u003c/p\u003e\n\u003cp\u003ePED\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Pediatric Emergency Department\u003c/p\u003e\n\u003cp\u003eRDT\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Rapid Diagnostic Test\u003c/p\u003e\n\u003cp\u003eRT-PCR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Real-Time Polymerase Chain Reaction\u003c/p\u003e\n\u003cp\u003eSARS-CoV-2\u0026nbsp; \u0026nbsp; \u0026nbsp;Severe Acute Respiratory Syndrome CoronaVirus 2\u003c/p\u003e\n\u003cp\u003eTAT\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Turnaround Time\u003c/p\u003e\n\u003cp\u003eTTD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Triage-to-discharge time\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e this study was conducted in accordance with the principles of the Declaration of Helsinki. This retrospective study was conducted using anonymized data collected for routine clinical care.\u0026nbsp;Our\u0026nbsp;local Ethical Committee reviewed the study protocol and determined that formal ethical approval was not required.\u0026nbsp;The study was reviewed by the Comitato Etico Territoriale - Liguria (CET Liguria), established by the Regional Government Resolution No. 478 dated May 26, 2023, and operational since January 1, 2024, under the administration of A.Li.Sa. (Azienda Ligure Sanitaria), Genoa, Italy.\u0026nbsp;As the study was retrospective and based on anonymized data, the requirement for informed consent was waived by the local Ethical Committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e the datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e the article processing charge (APC) was supported by\u0026nbsp;Relab, SD Biosensor\u003csup\u003eTM\u003c/sup\u003e. The company had no role in the study design, data collection, data analysis, data interpretation, writing of the manuscript, or the decision to submit for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e the authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003enot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e: Conceptualization, TB, GI, MV, MM; Data curation, GI, MV, BV, SM, FC, CP; Formal analysis, TB, MM; Supervision, BT, EP, AM; Visualization, TB, SM, FC, CP; Writing – original draft, TB, GI, MV; Writing – review \u0026amp; editing, BT, EP, AM. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e the authors thank the medical and nursing staff of the Pediatric Emergency Department of IRCCS Istituto Giannina Gaslini for their collaboration and support during the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTsai VW, Sharieff GQ, Kanegaye JT, Carlson LA, Harley J. Rapidmedicalassessment: improvingpediatricemergencydepartment time to provider, length of stay, and leftwithoutbeingseenrates. PediatrEmerg Care. 2012 Apr;28(4):354-6. doi: 10.1097/PEC.0b013e31824d9d27. PMID: 22453731.\u003c/li\u003e\n\u003cli\u003eGross TK, Lane NE, Timm NL; COMMITTEE ON PEDIATRIC EMERGENCY MEDICINE. Crowding in the Emergency Department: Challenges and Recommendations for the Care of Children. Pediatrics. 2023 Mar 1;151(3):e2022060971. doi: 10.1542/peds.2022-060971. 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Rapid influenza diagnostic test at triage can decrease emergency department length of stay. J Am CollEmerg Physicians Open. 2020 Jul 3;1(4):494-501. doi: 10.1002/emp2.12125. PMID: 33000076; PMCID: PMC7493520.\u003c/li\u003e\n\u003cli\u003eFjelltveit EB, Cox RJ, \u0026Oslash;stensj\u0026oslash; J, Blomberg B, Ebbesen MH, Langeland N, et al. Point-of-Care Influenza TestingImpactsClinicalDecision, Patient Flow, and Length of Stay in HospitalizedAdults. J InfectDis. 2022 Aug 12;226(1):97-108. doi: 10.1093/infdis/jiaa690. PMID: 33151320; PMCID: PMC9373161.\u003c/li\u003e\n\u003cli\u003eJeong HW, Heo JY, Park JS, Kim WJ. Effect of the influenza virus rapid antigen test on a physician\u0026apos;s decision to prescribe antibiotics and on patient length of stay in the emergency department. PLoS One. 2014 Nov 6;9(11):e110978. doi: 10.1371/journal.pone.0110978. PMID: 25375835; PMCID: PMC4222913.\u003c/li\u003e\n\u003cli\u003eBond KA, Smith B, Gardiner E, Liew KC, Williams E, Walsham N, et sl. Utility of SARS-CoV-2 rapidantigentesting for patient triage in the emergencydepartment: A clinicalimplementationstudy in Melbourne, Australia. Lancet Reg Health West Pac. 2022 May30;25:100486. doi: 10.1016/j.lanwpc.2022.100486. PMID: 35655473; PMCID: PMC9150863.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Adenovirus, Emergency Department Overcrowding, Fever, Influenza, Length of Stay, Pediatric Emergency Department, Point-of-Care Testing, Rapid Diagnostic Tests, Respiratory Infections","lastPublishedDoi":"10.21203/rs.3.rs-6546327/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6546327/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground. \u003c/strong\u003eOvercrowding in emergency departments (EDs), particularly pediatric emergency departments (PEDs), remains a significant challenge affecting patient outcomes and healthcare efficiency. Rapid diagnostic tests (RDTs) for respiratory viruses offer a potential approach to enhance patient management through prompt etiological diagnoses. This study evaluated the impact of point-of-care RDTs for influenza and adenovirus on length of stay (LOS) in a tertiary PED during epidemic seasons.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods.\u003c/strong\u003eA retrospective cohort study was conducted at IRCCS Istituto Giannina Gaslini, Genoa, Italy, over two epidemic seasons (December–February, 2023–2025). Pediatric patients with fever and respiratory symptoms who underwent bedside RDTs for influenza and/or adenovirus were included. LOS was assessed as time from triage to discharge (TTD) and physician acceptance to discharge (ATD). Patients were stratified by RDT results. Analyses between groups used Mann–Whitney U-test for continuous variables and chi-square or Fisher's exact test for categorical variables. A two-tailed p-value \u0026lt; 0.05 was considered significant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults. \u003c/strong\u003eOf 1,238 analyzed patients, median age was 3.3 years (IQR 1.4–7.2), with male predominance (58.1%). Overall, 330 patients (26.6%) tested positive for at least one virus. Positive RDT results showed shorter median TTD (217.0 vs. 239.0 minutes, p \u0026lt; 0.001) and ATD (66.0 vs. 148.5 minutes, p \u0026lt; 0.001) compared to negative results. These findings were consistent across virus types. No significant difference in 72-hour readmission rates was observed between groups, suggesting safe early discharge.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions. \u003c/strong\u003eRDTs for influenza and adenovirus in febrile pediatric patients with respiratory symptoms reduced PED LOS without increasing early return visits. These findings demonstrate RDTs' value in optimizing patient flow and reducing PED overcrowding. Future prospective studies and development of RDTs for additional respiratory pathogens are warranted to enhance emergency care efficiency.\u003c/p\u003e","manuscriptTitle":"Association Between Rapid Viral Testing and Reduced Length of Stay in a Pediatric Emergency Department During Epidemic Seasons: Implications for Overcrowding Management","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-01 06:06:15","doi":"10.21203/rs.3.rs-6546327/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"65b64771-1e47-4a3d-8cfd-5319288193bd","owner":[],"postedDate":"July 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-03T02:39:54+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-01 06:06:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6546327","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6546327","identity":"rs-6546327","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}