Association Between Rapid Viral Testing and Reduced Length of Stay in a Pediatric Emergency Department During Epidemic Seasons: Implications for Overcrowding Management

Background. Overcrowding in emergency departments (EDs), particularly pediatric emergency departments (PEDs), remains a significant challenge affecting patient outcomes and healthcare efficiency. Rapid diagnostic tests (RDTs) for respiratory viruses offer a potential approach to enhance patient management through prompt etiological diagnoses. This study evaluated the impact of point-of-care RDTs for influenza and adenovirus on length of stay (LOS) in a tertiary PED during epidemic seasons. Methods. A retrospective cohort study was conducted at IRCCS Istituto Giannina Gaslini, Genoa, Italy, over two epidemic seasons (December–February, 2023–2025). Pediatric patients with fever and respiratory symptoms who underwent bedside RDTs for influenza and/or adenovirus were included. LOS was assessed as time from triage to discharge (TTD) and physician acceptance to discharge (ATD). Patients were stratified by RDT results. Analyses between groups used Mann–Whitney U-test for continuous variables and chi-square or Fisher's exact test for categorical variables. A two-tailed p-value < 0.05 was considered significant. Results. Of 1,238 analyzed patients, median age was 3.3 years (IQR 1.4–7.2), with male predominance (58.1%). Overall, 330 patients (26.6%) tested positive for at least one virus. Positive RDT results showed shorter median TTD (217.0 vs. 239.0 minutes, p < 0.001) and ATD (66.0 vs. 148.5 minutes, p < 0.001) compared to negative results. These findings were consistent across virus types. No significant difference in 72-hour readmission rates was observed between groups, suggesting safe early discharge. Conclusions. RDTs for influenza and adenovirus in febrile pediatric patients with respiratory symptoms reduced PED LOS without increasing early return visits. These findings demonstrate RDTs' value in optimizing patient flow and reducing PED overcrowding. Future prospective studies and development of RDTs for additional respiratory pathogens are warranted to enhance emergency care efficiency.