# Evaluating the Clinical Impact of BioFire Spotfire R/ST on the Management of Pediatric Respiratory Presentations in the Emergency Department: A Pre–Post Cross-Sectional Study in Chile

## TL;DR

A new rapid test improved diagnosis and reduced hospitalizations for respiratory infections in Chilean children.

## Contribution

Demonstrated that implementing a rapid molecular test significantly improved clinical outcomes in pediatric emergency care.

## Key findings

- Etiological detection rate increased from 58.0% to 87.8% after implementing the test.
- Emergency department discharges rose from 23.7% to 57.3%, while hospitalizations dropped from 76.3% to 42.7%.
- Antimicrobial prescriptions and supplementary tests decreased significantly after test implementation.

## Abstract

Respiratory infections represent one of the leading causes of pediatric consultations and hospitalizations in Chile, where rapid etiological identification is essential for clinical decision-making. We evaluated the impact of implementing the BIOFIRE® SPOTFIRE® Respiratory (R) Panel in the pediatric Emergency Department of a public referral hospital in Santiago, using a pre–post cross-sectional design comparing two winter periods (July 2023 vs. July 2024). Clinical records, laboratory data, and operational indicators were analyzed to assess changes in diagnostic yield, turnaround time, hospitalizations, discharges, supplementary test requests, and antimicrobial use. A total of 470 patients were included (224 in 2023; 246 in 2024). The etiological detection rate increased from 58.0% to 87.8% after the implementation of Spotfire® (p < 0.0001), with marked increases in the identification of adenovirus, RSV, rhinovirus/enterovirus, and seasonal coronaviruses. Rapid molecular testing was associated with a significant rise in emergency department discharges (23.7% vs. 57.3%; p < 0.0001) and a reduction in hospitalizations (76.3% vs. 42.7%; p < 0.0001) and readmissions (9.2% vs. 0.5%; p < 0.0001). Requests for complete blood counts, chest X-rays, and antimicrobial prescriptions at discharge also decreased significantly. These effects persisted in key subgroups, including infants and children with comorbidities. In this high-demand winter setting, the BIOFIRE® SPOTFIRE® R Panel improved diagnostic performance and supported more efficient and targeted clinical management.