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The usefulness of a nasopharyngeal multiplex polymerase chain reaction system to screen pediatric patients with preoperative fever

Acta Anaesthesiologica Scandinavica

Submitted September 2023 by Dr Neil Hauser

Read by 222 Journal Watch subscribers

This single-center retrospective observational study investigated the utility of a PCR respiratory panel (PCR FilmArray Respiratory Panel 2.1, Biomeriuex) to determine whether surgery should proceed or be delayed in paediatric patients presenting pre-operatively with a fever. The authors argue that while it is well documented that children undergoing surgery with an active upper respiratory tract infection (URTI) are at risk of developing peri-operative respiratory adverse events (PRAE), not all pre-operative fevers are due to an active URTI.

As such patients admitted pre-operatively who had a temperature of greater than 38 degrees celsius (<1y/o) or >37.5 degrees (>1y/o) were subjected to a nasopharyngeal swab (NPS). The sample that was then put through the FilmArray panel testing for 22 different respiratory viruses. Patients who tested positive had their surgery deferred and were followed up to determine whether they developed symptoms consistent with an URTI. Patients who had a negative FilmArray panel were allowed to proceed to surgery and observed as to whether they developed any PRAE.

68 patients underwent a preoperative NPS in the study, with 1 excluded from the final analysis (total = 67). 28 tested positive for a viral infection on the FilmArray PCR test, with 25 included in the analysis (3 underwent surgery despite testing positive – reasons not given). Of those included in the analysis, 11/25 (44%) subsequently developed a viral illness on follow-up.

In the negative group, 39 patients had no viral infection detected on FilmArray, despite their pre-operative temperature (1 was excluded from analysis as the surgeons delayed the operation – reason not given). Of the included 38 negative patients, none developed any PRAE. Although there was a statistically significant difference between the groups in terms of the proportion of patients that developed symptoms (p <0.001) and there was a positive OR of 29.6, the confidence intervals for this result were very large indeed (3.80 – 1356.01).

Take home messages/commentary:
The authors suggest the utility of this study lies in the potential use of the FimArray to screen paediatric patients presenting with a fever pre-operatively. The test is relatively quick to perform, and results are available within 45mins. While the risk of the patient developing features of a viral infection following a positive screening test is ultimately 50/50 there is reassurance in proceeding with a negative test as none of these patients developed any PRAE despite their preoperative fever.

Limitations include its retrospective nature, small numbers at a single-center and the fact that patients testing positive may have had an infection in the proceeding 6-8 weeks with a PCR test remaining positive for some time following infection. This may mean that some patients will have their surgery unnecessarily postponed as they may in fact not go on to develop PRAE.

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