Abstract
Background
Respiratory Syncytial Virus (RSV) has been recognized for over half a century as a
cause of morbidity in infants and children. Over the past 20 years, data has emerged linking RSV as a cause of illness in adults resulting in 177,000
annual hospitalizations and up to 14,000 deaths among older adults.
Objective
Characterize clinical variables in a cohort of adult RSV patients. We hypothesize
that emergency physicians do not routinely consider RSV in the differential diagnosis
(DDx) of influenza like illness.
Methods
Observational study of all adult inpatients, age ≥ 19, with a positive RSV swab ordered within 48 h of their hospital visit, including their emergency department (ED) visit, and who
initially presented to a university affiliated urban 100,000 annual visit emergency
department from 2007 to 2014. A data collection form was created, and a single trained
clinical research assistant abstracted demographic, clinical variables. ED providers
were given credit for RSV DDx if an RSV swab was ordered as part of the diagnostic
ED workup. Results: 295 consecutive inpatients (mean age = 66.5 years, range, 19–97, 53% male) were RSV positive during the 7-year study period. 207
cases (70%) were age ≥ 60. 76 (26%) had fever, 86 (29%) had O2sat <92% and 145 (49%) had wheezing. 279 patients required admission, 30 needed ICU stay
and overall mortality was 12 patients (4%). Age ≥ 60 was associated with overall mortality (p = 0.09). There were 106 (36%) immunocompromised patients (23% transplant, 40% cancer,
33% steroid use) in the cohort. A diagnosis of RSV was considered in the ED in 105
(36%) of patients. Being immunocompromised, having COPD/asthma, O2sat <92, or wheezing did not alert the ED provider to order an RSV test.
Conclusion
Adults can harbor RSV as this can lead to significant mobility and mortality, especially
in individuals who are over the age of 60. RSV is not being considered in the DDx
diagnosis, and this was especially surprising in the transplant/immunocompromised
subgroups. Given antiviral treatment options, educational efforts should be undertaken
to raise awareness of RSV in adults.
Keywords
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Article Info
Publication History
Published online: June 11, 2017
Accepted:
June 10,
2017
Received in revised form:
June 8,
2017
Received:
July 27,
2016
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.