Rapid Genome and Exome Sequencing in Inpatients: Clinical Impact at a Tertiary Academic Medical Center

The objective of this study is to describe outcomes of rapid exome (rES) and rapid genome sequencing (rGS) in an inpatient setting. This is a retrospective cohort of inpatients with rES or rGS during their hospitalization between April 2016 and November 2023. Medical records were reviewed to measure primary outcomes: diagnostic yield, medical management changes, and anticipatory guidance updates. Descriptive analysis and formal comparisons (Welch's t-test with post hoc power analysis, Fischer's exact test) were performed, with rES and rGS comparisons limited to 2023 due to test distribution. Of 95 patients, most (74.7% [71/95]) were < 12 months old and admitted in neonatal (44.2% [42/95]) or pediatric (29.5% [28/95]) intensive care units. Common indications for rapid sequencing included multiple congenital anomalies (24.2% [23/95]), neurological concerns (23.3% [22/95]), and acute illness (16.8% [16/95]). Mean turnaround time of testing significantly shortened for rES from 2021 (13.2 [SD = 5.9] days) to 2023 (8.1 [SD = 4.1] days) (p-value = 0.018; power = 0.74). Diagnostic yield was 29.5% (28/95) and did not significantly differ between rES (13.6% [3/22]) and rGS (35.0% [7/20]) (p-value = 0.15). Sequencing led to medical management changes (86.0% [74/86]) and anticipatory guidance updates (41.4% [39/95]) with similar rates observed in diagnostic and non-diagnostic tests. Our findings suggest rES or rGS implementation may influence diagnosis and care strategies in critically ill patients.