Respiratory syncytial virus (RSV) is substantially underdiagnosed during pediatric office visits. A recent prospective survey found the illness is responsible for one in 13 visits by young children to a
primary-care provider (PCP).

The study used data from 5,067 children younger than 5 years who were treated in hospitals, emergency departments (EDs), or PCP offices. All patients were diagnosed with an acute respiratory infection. They presented with at least one of these symptoms: fever; cough; earache; nasal congestion; rhinorrhea; sore throat; vomit after coughing; wheezing; and labored, rapid, or shallow breathing.

Nasal and throat swabs were taken from each patient. Treatment choices were left to the clinicians, and the research team later reviewed test results and other clinical data.

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Overall, 919 cases (18%) were confirmed as RSV in origin. Although the virus was associated with 15% of PCP visits for acute respiratory infections, it was diagnosed in only 3% of the patients. Bronchitis was diagnosed in 20% of the children actually infected with RSV (N Engl J Med. 2009;360:588-598).

Extrapolating their data to a national level, the survey estimated that 2.1 million children younger than 5 years require treatment for RSV each year. Most of the burden falls on PCPs, who treat 73% of these children, compared with 25% seen in EDs and about 3% who are hospitalized. More than 1.3 million of the PCP patients (61%) are aged 2-5 years.

The children seen in PCP offices are generally quite ill, the authors note. “About three fourths have labored breathing, which is similar to the proportion of children with RSV who are sent to the ED.”