Diagnosis of ARI was based on clinical examination by admitting doctor necessary and case notes were reviewed Inhibitors,Modulators,Libraries to confirm coded diagnosis. Alder Hey is a large, university affiliated paediatric teaching hospital with a catchment area of 7. 5 million people and more than 270,000 patient care episodes per annum, including 65,000 children seen in the emergency department. Subjects Inclusion criteria Inhibitors,Modulators,Libraries All children aged 0 16 years, symptomatic of ARI from whom respiratory virus Inhibitors,Modulators,Libraries samples were taken, either at presentation to hospital or within 7 days of admission. Patients who had been admitted for surgery but developed PCR positive ARI within 7 days of admission were included, as this time frame incorporates the incubation period for all of the viruses studied.

Data for these patients are highlighted as they were initially elective admissions and thus may display different clinical characteristics to those for whom ARI was the primary cause of admission. Data was collected on clinical characteristics of the ARI including Inhibitors,Modulators,Libraries disease severity, presence of any co morbidities and length of hospital stay. Co morbidities were recorded in the categories of haematology oncology, respiratory, cardiac, neurological, congenital chromosomal and other . Pathogen detection A number of sampling methods were used nose throat swabs, nasopharyngeal aspirate, endotracheal aspirate, bronchoalveolar lavage and sputum. Remel MicroTest M4RT was the transport medium used. The type of sample collected was at the discretion of clinical staff. Respiratory samples were analysed in one of two ways.

either with a rapid RSV test Inhibitors,Modulators,Libraries if the patient had symptoms suggestive of bronchiolitis, followed by multiplex PCR testing for ten respiratory viruses, or with multiplex PCR testing alone if the patient had suspected other ARI. RSV testing This was completed on site, using BinaxNOW RSV kit according to the manufacturers instructions. The test is performed on nasopharyngeal aspirates and detects RSV fusion protein antigen. Respiratory virus PCR analysis The respiratory PCR screening inhibitor Volasertib assay comprises 5 multiplex reactions detecting a total of 10 respiratory viruses. The multiplex reactions detect influenza A and influenza B, respiratory syncytial virus and human metapneumovirus, adenovirus and human rhinovirus, parainfluenza type 1, 2 and 3 and a specific assay for the detection of the 2009 pdmH1N1 based on a National Standard Method developed by the Health Protection Agency Microbiology Services. The 2009 pdmH1N1 assay was done if initial PCR was positive for influenza A.