Fırat BEDİR, Mahmut ALTUNTAŞ
The Journal of Pediatric Research - 2026;13(3):263-271
Aim: To compare virus-specific clinical patterns predictive of early hospitalization within 7 days following emergency department (ED) discharge among children with polymerase chain reaction (PCR)-confirmed coronavirus disease-2019 (COVID-19), respiratory syncytial virus (RSV), and influenza. Materials and Methods: This retrospective cohort study included children aged 0-18 years with PCR-confirmed COVID-19, RSV, or influenza who presented to the pediatric ED of a tertiary-care university hospital between January, 2020 and December, 2024 and who were initially discharged at the index visit. The primary outcome was hospitalization within 7 days following ED discharge. Multivariable logistic regression models were constructed separately for each viral etiology in order to identify virus-specific predictors of early hospitalization within 7 days. Results: Among the 6,700 children included, hospitalization within 7 days occurred in 7.8% of COVID-19 cases, 9.0% of RSV cases, and 7.0% of influenza cases. In the COVID-19 cases, C-reactive protein >=33 mg/L [adjusted odds ratio (aOR) 2.8, 95% confidence interval (CI): 1.7-4.3] and persistent fever longer than 3 days (aOR 3.2, 95% CI: 1.9-4.9) were independently associated with early hospitalizations. In the RSV cases, respiratory distress was the strongest predictor (aOR 3.7, 95% CI: 2.2-5.9). In the influenza cases, persistent systemic symptoms were independently associated with hospitalizations (aOR 3.1, 95% CI: 1.8-4.7). Conclusion: Early hospitalization following ED discharge shows distinct clinical patterns across viral etiologies in children. Incorporating etiology-informed, readily available clinical features at ED presentation into discharge planning may improve the safety of outpatient management and support targeted early follow-up.
