Study Identifies High Costs of Potentially Unneeded Respiratory Testing in Children: Cincinnati Children's

The COVID pandemic disrupted routine testing practices for flu, RSV, and other common infections. Now expensive "large-panel" tests appear over-used.

CINCINNATI, March 6, 2025 /PRNewswire/ -- Pediatric hospitals appear to be ordering more large-panel tests when children are brought to the hospital for respiratory tract infections, according to a study published March 4, 2025, in JAMA Network Open.

This change in testing practices traces back to the crisis days early in the COVID-19 pandemic, but has continued well past the overall decline in SARS-CoV-2 viral infections that has occurred since. The surge in overall test orders, including "large-panel" tests that look for more than five possible infectious causes at once, is adding millions in potentially unneeded spending, the study co-authors report.

The study was conducted by a multi-center team of experts led by Matthew Molloy, MD, MPH, Division of Hospital Medicine at Cincinnati Children's. Using data from the national Pediatric Health Information System, the study tracked several years of testing and expense data from more than 5 million patient hospital encounters across the US.

"We found a persistently increasing rate of large-panel testing over the study period. These increases were associated with a 4-fold increase in the costs of respiratory testing and underscore the need for future deimplementation efforts," Molloy says.

Key Findings 

• The rate of test ordering has grown for children with respiratory infections. In 2016, tests were ordered for 13.6% of sick children arriving at emergency departments. By 2022, the rate had soared to 62.2% of encounters.
• The types of test ordered also changed. Instead of relying primarily on lower-cost single-virus tests, the numbers surged for mid-level tests checking for 3 to 5 types of infection and for large-panel tests checking for 6 or more conditions. As a result, testing costs grew from $34.20 per encounter in 2017 to $128.20 in 2022.
• Adjusted for inflation, the national cost of respiratory pathogen testing rose from $20.6 million in 2016 to $111 million in 2022.

As the team tracked the testing trends, the disruption caused by the pandemic became obvious. Several years of steady, seasonal ups and downs in respiratory testing frequency clearly tracked annual winter flu seasons. Once the pandemic arrived, the testing rates soared and haven't returned to the seasonal pattern.

Even before the pandemic struck, leaders in pediatric medicine were urging clinicians to be judicious with respiratory tests because in many cases, conducting more tests results in no changes in treatment, and has no impact on outcomes. More testing also has shown little to no impact on the overuse of antibiotics that have no value when treating a viral infection.

The challenge becomes how to drive practices back toward more-targeted testing, a process experts in the field call "deimplementation."

"These findings are likely to be interesting to clinicians and health policy professionals who could help drive future deimplementation efforts to make sure we approach testing through a lens of providing the most value to our patients and our health system," Molloy says.

About the study

Contributors to this study included Matthew Hall, PhD, with the Children's Hospital Association, and experts from Children's Mercy Kansas City, University of Kansas, Children's Hospital Colorado, Le Bonheur Children's Hospital, Children's Healthcare of Atlanta, University of North Carolina, Children's Medical Center Dallas, University of Chicago, Arkansas Children's Northwest, Children's National Hospital, and Dartmouth Health Children's.

Funding sources for the study included the National Institutes of Health (NIH, the National Center for Advancing Translational Sciences (NCATS), and the Agency for Healthcare Research and Quality (AHRQ).

SOURCE Cincinnati Children's Hospital Medical Center