Barbara Vanorio

Background. Overcrowding in emergency departments (EDs), particularly pediatric emergency departments (PEDs), remains a significant challenge that affects patient outcomes and the efficiency of healthcare. Rapid diagnostic tests (RDTs) for respiratory viruses could be a promising tool for improving patient management by enabling prompt etiological diagnoses. This study investigated whether positive RDT results for influenza or adenovirus were associated with differences in 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). All consecutive pediatric patients presenting with fever and respiratory symptoms who underwent rapid diagnostic testing for influenza and/or adenovirus during two epidemic seasons were included. LOS was assessed as the time from triage to discharge (TTD) and from physician assignment to discharge (ATD). Patients were stratified by positive versus negative RDT results. Analyses between groups used the 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 the 1238 patients analyzed, the median age was 3.3 years (IQR 1.4–7.2), with male predominance (58.1%). A total of 330 patients (26.6%) tested positive. Compared with negative results, positive RDTs were associated with shorter median TTD (217.0 vs. 239.0 min, p < 0.001) and ATD (66.0 vs. 148.5 min, p < 0.001), which was consistent in both the influenza and adenovirus subgroups. No significant difference in 72 h readmission rates was observed between groups. Conclusions. Among children tested with RDTs for influenza and adenovirus, positive results were associated with reduced PED LOS without increasing early return visits. While these findings suggest a potential role in supporting patient flow, conclusions regarding the broader impact on PED overcrowding should be drawn with caution. Further prospective studies, including non-tested controls and additional viral targets, are required.

Background: Respiratory tract infections (RTIs) are a leading cause of pediatric emergency department (PED) visits, especially in children under five. These infections are primarily viral, complicating diagnosis and management. This study assesses the impact of point-of-care (POC) rapid diagnostic tests for respiratory viruses on clinical and economic outcomes in a PED setting. Materials and Methods: A retrospective analysis of 1396 POC tests for RSV, adenovirus, and influenza A/B was conducted in the PED of the Giannina Gaslini Institute, Genoa, Italy, from December 2022 to April 2024. Demographics, blood tests, admissions, and readmission rates were evaluated. Statistical analyses were performed using appropriate tests for categorical and continuous variables. Results: Of the tests, 31.5% were positive for at least one virus. Positive patients were younger and had higher hospitalization rates (50.7% vs. 39.9%) but fewer blood tests (38.2% vs. 51.7%). Economic analysis indicated lower costs for virus-positive patients. RSV-positive patients showed a significant association with higher hospitalization rates (67.8%) and readmission within 72 h. Conclusions: POC testing significantly improves patient management in PEDs by enabling rapid diagnoses, reducing unnecessary tests and hospitalizations, and guiding appropriate treatment. This approach supports better resource allocation, crucial during peak seasons, and has implications for reducing antibiotic use and resistance. Further research is warranted to explore long-term impacts on patient outcomes and healthcare efficiency.

Zinc deficiency is a significant global health concern among children, manifesting in various acquired and inherited conditions. This comprehensive overview of acquired and inherited zinc deficiency-related diseases in children aimed to explore the clinical presentations, diagnostic challenges, and management strategies associated with these conditions. This case series elucidates the diverse clinical manifestations of zinc deficiency in pediatric patients, ranging from dermatitis and growth retardation to immune dysregulation and neurological abnormalities, and discusses the underlying genetic mechanisms, clinical phenotypes, and therapeutic interventions. The complexity of zinc deficiency-related diseases in children underscores the need for a multidisciplinary approach involving pediatricians, dermatologists, geneticists, and nutritionists to optimize patient care and outcomes.