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5m Read

October 08, 2026

RESPIRATORY HEALTH

Article

Goldilocks Diagnostics: Finding the Right Respiratory Test for the Right Patient

As respiratory viruses co-circulate and present with overlapping symptoms, clinicians increasingly face a fundamental question: How much diagnostic information is enough? The most comprehensive test is not always the most useful one, while overly narrow testing may leave important questions unanswered. The key is selecting the option that is neither too little nor too much, but just right.

That is the role of diagnostic stewardship: selecting the most appropriate test for the patient, at the right time, to support clinical decision-making. This approach supports the CDC’s Core Elements of Hospital Diagnostic Excellence (DxEx),1 which emphasizes timely, accurate, communicative, and patient-centered diagnostic processes. In respiratory testing, that means choosing an approach that provides enough information to guide care without creating unnecessary complexity.

 

Start with the Clinical Question

Before selecting a testing strategy, clinicians may consider several factors:

  • What information is needed to support patient management?
  • How likely is a particular pathogen?
  • How much diagnostic uncertainty exists?
  • Could broader pathogen identification influence clinical decision-making?
  • What are the potential consequences of missing an alternative diagnosis?

 

The answers to these questions may differ across patients and care settings, making flexibility an important component of respiratory testing.

“The goal is to use them in situations where it will make a difference for patient management.” - Healthcare provider respondent Society for Healthcare Epidemiology of America Research Network survey.

A Spectrum of Respiratory Testing Options

This need for right-sized testing is especially relevant as respiratory panels become more commonly used across clinical settings. The role of respiratory panels in improving diagnosis, patient management, and clinical outcomes is still evolving.2

A practical approach is to match the breadth of respiratory testing to the patient’s presentation, clinical setting, and degree of diagnostic uncertainty.

The Respiratory Testing Spectrum

# of pathogens is indicated for Cepheid example tests

When a Focused Answer Is the Best Answer

In some situations, clinicians may have a relatively narrow diagnostic question.

During periods of high influenza activity (high pretest probability), for example, the primary objective may be confirming influenza if the diagnosis will change patient management.3 In other cases, patient history, exposure risk, local epidemiology, or clinical presentation may point toward a specific pathogen.

When the clinical question is focused, targeted testing can provide actionable information quickly and efficiently.  Rather than generating additional information that may not change management, the goal is to answer the question most relevant to the patient at that moment, avoiding over-testing, unnecessary antimicrobial treatment, and excess cost.4

Cepheid offers targeted respiratory testing options designed to support focused clinical questions, including tests for influenza A and B, SARS-CoV-2, and Group A Streptococcus.

When Differentiation Matters

Respiratory illness symptoms are often non-specific.5 Fever, cough, malaise, congestion, and shortness of breath can be associated with multiple viral and bacterial pathogens.6 In these situations, clinicians may need to determine which of several common or co-circulating pathogens is responsible.5,7

A low-plex respiratory panel (~2-5 targets) can help answer that question by distinguishing among common circulating viruses while maintaining a focused testing approach. For many clinical scenarios, particularly in outpatient settings, this balance may provide the right amount of diagnostic information without expanding beyond the pathogens most likely to impact patient management.7

Cepheid's Xpert Xpress CoV-2/Flu/RSV plus test provides a focused panel approach for differentiating among common viral causes of respiratory illness.

When Broader Insight Can Support Clinical Decision-Making

There are also situations where broader pathogen identification may provide additional value.7,8

Broader testing may be considered when:7,8

  • Multiple respiratory pathogens could plausibly explain symptoms
  • The diagnosis remains uncertain (e.g. after using a targeted approach)
  • Additional diagnostic confidence may support management decisions
  • The patient is at higher risk, e.g. hospitalized, immunocompromised, pediatric, or older populations


As the complexity of the clinical question increases, the amount of information needed to answer it may increase as well.

The Xpert Respiratory Panel provides a mid-plex testing option designed to detect 13 respiratory (9 viral; 4 bacterial) pathogens when clinical circumstances warrant additional information.

Why Choice Matters

The evolution of respiratory diagnostics has created new opportunities to align testing with patient needs rather than relying on a one-size-fits-all approach.

The goal of diagnostic stewardship is to select the option that provides the information needed to support confident clinical decision-making.

By offering targeted, low-plex and mid-plex respiratory testing options, Cepheid's respiratory test portfolio can help align test selection with a range of clinical questions and care settings.

In respiratory diagnostics, the right answer is the one that best fits the patient, the setting, and the clinical question.

 

 

Additional resources

Product information: Learn more about Cepheid’s respiratory testing solutions

Education: A Quick Primer on the ADLM Guidance on Respiratory Virus Testing

Expert Perspective: Innovation in the Era of Diagnostic Excellence

Expert Perspective: The “Goldilocks Approach” to molecular diagnostics stewardship

Article: Multiplex with Meaning: Cepheid’s Smart Approach to Molecular Diagnostic Testing

 

IVD. In Vitro Diagnostic Medical Device. May not be available in all countries.

References

1.      CDC. Core Elements of Hospital Diagnostic Excellence (DxEx). https://www.cdc.gov/patient-safety/hcp/hospital-dx-excellence/index.html  Accessed August 2026

2.      Baghdadi JD et al. Diagnostic stewardship to support optimal use of multiplex molecular respiratory panels: A survey from the Society for Healthcare Epidemiology of America Research Network. Infect Control Hosp Epidemiol. 2023 Nov;44(11):1823-1828. doi: 10.1017/ice.2023.72. Epub 2023 May 2. PMID: 37129035; PMCID: PMC10862355. https://pubmed.ncbi.nlm.nih.gov/37129035/ Accessed August 2026

3.      CDC. Guide for considering influenza testing when influenza viruses are circulating in the community. Dec. 19, 2025. https://www.cdc.gov/flu/hcp/testing-methods/consider-influenza-testing.html Accessed August 2026

4.      Fabre V et al. Principles of diagnostic stewardship: A practical guide from the Society for Healthcare Epidemiology of America Diagnostic Stewardship Task Force. Infect Control Hosp Epidemiol. 2023;44(2):178-185. doi:10.1017/ice.2023.5.

5.      CDC. Multiplex Tests to Detect Influenza, SARS-CoV-2, and RSV. April 27, 2026. https://www.cdc.gov/flu/hcp/testing-methods/flu-covid19-detection.html Accessed August 2026

6.      CDC. About Respiratory Illnesses. August 18, 2025. https://www.cdc.gov/respiratory-viruses/about/index.html  Accessed August 2026

7.      Berry GJ, Jhaveri TA, Larkin PMK, Mostafa H, Babady NE. ADLM guidance document on laboratory diagnosis of respiratory viruses. [Epub] J Appl Lab Med May 2, 2024, as doi: 10.1093/jalm/jfae010.

Hanson KE, Azar MM, Banerjee R, et al. Molecular testing for acute respiratory tract infections: clinical and diagnostic recommendations from the IDSA's diagnostics committee. Clin Infect Dis. 2020; 71(10): 2744-2751. doi:10.1093/cid/ciaa508 Accessed August 2026

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