Summary of Key Study Results by Outcome

StudyaResource UseSubgroups/Pleocytosis
Stellrecht et al7In infants <3 mo of age (n = 31), a positive correlation was found between decreased turnaround time and decreasing LOS (r2, 0.92, P = .009).16 of 31 were EV positive and, of those, only 44% (95% CI 19.8%–70.1%) had CSF pleocytosis.
Dewan et al8The EV-positive infants had 26% shorter LOS compared with those infants that were not tested, with adjusted β coefficient, –0.305 (95% CI –0.457 to –0.153, P < .001).NI
Ramers et al9In a subgroup of 146 infants <1 mo old with pleocytosis, LOS (median 42.5 vs 71 h) and time from PCR result to discharge (median 7.2 vs 28 h) were shorter for EV-positive patients compared with EV-negative patients. Less had CT/MRI (10% vs 71%), radiographs (26% vs 80%), EEG (3% vs 27%), and median days IV antibiotics (2 vs 4 d) occurred for EV-positive patients compared with those with a negative test (P < .001 for all comparisons).Pleocytosis reported for EV-positive infants <1 mo old and 1–2 mo of age. However, possible discrepancies were seen in the numbers in various parts of the manuscript.
Nigrovic et al10EV PCR testing can lead to cost savings when the prevalence of EV is >13.5% with the assumption of discharge of 50% of infants with a positive PCR after 24 h of hospitalization.bNI
Byington et al11NINo difference in age, sex, LOS, temperature, or duration of symptoms between EV-positive and EV-negative infants.
Yun et al12NI68%–77% of 22 infants <1 mo old did not have CSF pleocytosis.
Seiden et al13NICSF pleocytosis present in 71% (n = 109/154) of patients and increased with age in 59%, 74%, and 90% of infants aged 0–28, 29–56, and 57–90 d, respectively (P = .007).
Mulford et al14NIFor infants ≤2 mo of age: sensitivity of pleocytosis, 70% (95% CI, 59%–79%), specificity, 73% (95% CI, 63%–81%), PPV, 69% (95% CI, 58%–79%), NPV, 74% (95% CI, 64%–82%). Test properties for CSF protein were not reported for this age group.
  • CT, computed tomography; EV, enterovirus; IV, intravenous; NI, not included; NPV, negative predictive value; PPV, positive predictive value.

  • a Studies are listed by the order of citation in the text. For studies that included an older population, the results are reported for the subgroup of infants <90 days of age. The upper age limit of the subgroup reported varies by study.

  • b Results reported according to the decision tree assumption suitable for infants 0 to 90 days of age.