OBJECTIVES:

To characterize hospitalizations and outcomes of children aged 1 to 4 with influenza-like illness (ILI) from viruses including Respiratory syncytial virus (RSV), Influenza, human metapneumovirus (hMPV), parainfluenza (PIV), Adenovirus, and Rhinovirus.

METHODS:

This analysis used data from the 2016-2019 Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS). Hospitalizations for children 1 to 4 years of age with a single virus were identified using ICD-10 codes. In-hospital mortality, length of stay in days (LOS), and cost-to-charge ratio adjusted charges (costs) were analyzed using nested multivariable regression models. Models were adjusted for patient and hospital characteristics, and number of Feudtner’s Chronic Comorbidity Categories. All summaries and models accounted for hospital NIS-weights.

RESULTS:

A weighted total of 172,705 hospitalizations were identified. RSV and Influenza accounted for 58.3% and 21.9% followed by Adenovirus (10%), while hMPV, PIV, and Rhinovirus made up 7%, 1.6%, and 1.3%, respectively. Overall median (Q1-Q3) costs were $4,208 ($2,229-$8,717) and LOS of 1.84 (0.74-3.52). PIV had the largest costs and LOS of $8,580 ($3,769-$19,280) and 2.92 (1.41-6.37) followed by hMPV with LOS=2.86 (1.52-5.16), and costs=$6,920 ($3,672-$14,595).

Overall weighted mortality was 530 (0.3%), of which RSV and Adenovirus were present in 63.2%. Asthma was present in 25.6% hospitalizations, of which 3.8% were with acute exacerbation. Top outcomes included bronchiolitis (53.0%), acute respiratory failure (18.7%) and viral pneumonia (16.4%).

The adjusted odds ratio (aOR) of mortality for Adenovirus and hMPV were aOR=2.98 [95% CI=(1.67-5.30)] and aOR=2.54 [95% CI=(1.39-4.64)], respectively. Adjusted mean costs ranged from $3,980-$5,957 and adjusted mean LOS ranged from 2.37-3.15, with PIV having the largest in both.

CONCLUSIONS:

ILI from common and less frequently reported viral pathogens resulted in significant increases in respiratory disorders, LOS and costs. PIV was associated with greater costs and longer LOS, while Adenovirus and hMPV were associated with increased odds of mortality.