Background: Respiratory syncytial virus (RSV) accounts for a significant health burden worldwide. However, current policies do not support routine RSV testing of clinical lower respiratory tract infections (LRTIs). A systematic literature review was conducted to describe and review historical and current RSV testing policy and practice (e.g., AAP 2014) and RSV tests and their performance in the United States.

Results: The literature searches identified 5,454 de-duplicated articles that were reviewed for relevance at the level of title and abstract. Of these, 18% met the inclusion criteria for full-text review, and approximately 397 articles were included for qualitative synthesis. However, although significant RSV burden was observed in the literature among U.S. infants and children up to 5 years of age, <20% of the included articles were relevant for evaluating RSV testing policy, practice, and management in the U.S. Substantial heterogeneity was observed in RSV case definition, testing practices, and quality across the included studies. Most studies did not confirm an RSV diagnosis with laboratory testing. In addition, a wide range of testing methods were used to confirm RSV infection. Further, limited information was available on ICD coding practices for RSV testing and testing results.

Conclusions: This comprehensive review highlights the need for a standardized RSV case definition, testing practice, and management. Application of these elements in the clinical setting through systematic primary, prospective data generation utilizing electronic health records and classic clinical surveillance would provide critical information for further delineating the case definition for RSV.