Herpes Simplex Virus Testing and Hospital Length of Stay in Neonates and Young Infants

Objective To examine whether ordering testing of cerebrospinal fluid (CSF) for herpes simplex virus (HSV) by polymerase chain reaction (PCR) in neonates and young infants is associated with increased hospital length of stay (LOS) or increased hospital charges. Study design This retrospective cohort study enrolled infants age <= 56 days who underwent lumbar puncture in the emergency department in 2005-2006. The primary "exposure" was CSF HSV PCR, and the primary outcomes were LOS and hospital charges. Results CSF HSV PCR was performed in 282 of 889 eligible infants (31.7%). The median test turnaround time was 22 hours. The median LOS was 2 days, and median hospital charge was $10 166. In multivariate analysis, CSF HSV PCR testing was associated with a LOS increase of 28% for infants age <= 28 days and 39% for infants age 29-56 days. LOS increased by 22% for every 12-hour increase in test turnaround time. CSF HSV PCR testing was associated with a 41% increase in hospital charges. Conclusions In infants evaluated by lumbar puncture in the emergency department, CSF HSV PCR testing was associated with a significantly longer LOS and higher hospital charges. (J Pediatr 2010; 156: 738-43).