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BACKGROUND: Differentiating bacterial from viral infection in the clinical setting is a challenge faced by physicians and often leading to antibiotic misuse. ImmunoXpert™ is a novel host-based assay integrating three inflammatory proteins: Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), interferon gamma induced protein-10 (IP-10) and C-reactive protein (CRP). In this analysis we aimed to examine the performance of the host-based assay in pediatric patients with Influenza infection.

METHODS: The study population included pediatric patients enrolled at the pediatric division of a secondary medical center in Israel. Patients with a confirmed Influenza A infection according to a nasal swab real-time PCR were tested with ImmunoXpert assay during the winter seasons of 2017/2018 and 2018/2019. Bacterial or viral etiologies were determined by unanimous agreement of a three senior pediatrician panel, based on clinical, laboratory and radiological data. Experts were blinded to the assay result. The assay gives one of three outcomes: bacterial, viral or equivocal.

FINDINGS: Sixty-one children aged 0-17 years (mean 4.75 years), 60% female, had a PCR-confirmed Influenza A infection and ImmunoXpert™ test result. Of these, 2 were labeled as bacterial, 48 as viral and 11 were indeterminate. The assay demonstrated sensitivity of 100% (95% CI: 15.81%-100%), specificity of 86.96% (95% CI: 73.74%-95.06%) and negative predictive value of 100% (95% CI: 100%-100%); equivocal result rate was 5%.

CONCLUSION: ImmunXpert™ exhibited high diagnostic performance for distinguishing simple viral from viral-bacterial coinfection in influenza positive patients. Large-scale prospective cohort studies are warranted to support the assay’s potential to improve antimicrobial treatment decisions.

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Background and Aims

Children with bronchopulmonary dysplasia (BPD) show airflow obstruction and altered ventilatory response to exercise throughout childhood. Expiratory flow limitation promotes dynamic hyperinflation and respiratory muscle weakness; the significance of this in BPD is unclear as it cannot be measured by standard cardiopulmonary exercise testing. Optoeletronic plethysmography (OEP) is a motion analysis system that directly measures thoracoabdominal volumes. We assessed feasibility of OEP in children to directly assess dynamic hyperinflation in BPD.

Methods

Children aged 10-15 years with moderate/severe BPD (n=17) and healthy controls (n=9) were recruited. Standard lung function and peak exercise testing using OEP were performed.

Results

Children with BPD showed significant baseline flow limitation, impaired gas exchange and greater bronchodilator response than controls. Children with BPD achieved a significantly lower minute ventilation than controls and showed a significant reduction in FEV₁ with exercise (table).

At peak exercise, total end-expiratory volume was not significantly different, but children with BPD showed a trend toward ribcage hyperinflation, with compensatory reduction in end-expiratory abdominal volume.

Conclusions

OEP can assess ventilatory response to exercise in children and identified a trend toward rib cage hyperinflation in BPD. Further assessment in a larger cohort is required.

Median (IQR). *p=<0.05.

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Introduction. Reconfiguration of inpatient services in a hospital includes complete and partial closure of all emergency inpatient facilities. This study addressed the question does admission prevalence change after reconfiguration of inpatient services?

Methods. The number of emergency admissions per month to hospitals within health boards (i.e. geographical areas) where an inpatient facility was reconfigured was obtained for five years prior to reconfiguration and up to five years afterwards. An interrupted time series analysis considered the relationship between reconfiguration on admissions across pairs comprised of “reconfigured” and “adjacent” hospitals, with adjustment for seasonality and an overall rising trend in admissions.

Results. Inpatient services were reconfigured in five hospitals, including two immediate closures, two with closure only to overnight admissions and one with overnight closure for a period and then closure. In “reconfigured” hospitals there was an average fall of 117 admissions/month [95% CI 78, 156] in the year after reconfiguration compared to the year before, and in “adjacent” hospitals admissions typically rose by 82/month [32, 131]. Across paired reconfigured and adjacent hospitals, in the months post reconfiguration the number of admissions to one hospital pair slowed, in another pair admissions accelerated, and admission prevalence was unchanged in three pairs.

Conclusions. There are diverse outcomes for the number of emergency admissions post reconfiguration of inpatient facilities. Policy makers considering reconfiguration might consider a number of factors which may be important determinants of admissions post reconfiguration.