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Cough, fever may be reliable prediction model for influenza
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A predictive model that includes cough and fever for all ages, and rhinorrhea for children aged younger than 5 years, may help identify influenza among patients presenting to the ED with influenza-like illness, researchers from Rush University Medical Center have found.
“This simplified case definition of fever and cough could easily be implemented in the clinical setting to rapidly identify and treat potential influenza cases, as well as to assist public health departments with influenza outbreak monitoring and surveillance,” the researchers wrote in Infection Control and Hospital Epidemiology. “For the high-risk group of children [aged younger than 5 years], inclusion of rhinorrhea in the case definition would improve detection of influenza, but should be further explored through additional prospective studies with larger sample sizes.”
The researchers conducted a retrospective, cross-sectional study in an ED in Chicago during two periods of widespread influenza: Aug. 30, 2009 to Jan. 2, 2010 and Nov. 28, 2010 to March 26, 2011. The cohort included 1,581 patients who had nasopharyngeal specimens tested for respiratory viruses based on physician clinical judgment. The researchers reviewed the patients’ electronic medical records for 29 terms potentially associated with influenza signs and symptoms.
Among the 1,581 swab specimens tested, 12.3% of cases were confirmed influenza. Most of the specimens were from patients aged younger than 50 years, and 27% were aged 0 to 4 years. Among the influenza cases, 93.8% presented with fever and 94.3% presented with cough. In a multivariate analysis, four symptoms served as a predictive model: cough (diagnostic OR = 5.87; 95% CI, 3.09-11.12), fever (DOR = 4.49; 95% CI, 2.43-8.31), rhinorrhea (DOR = 1.98; 95% CI, 1.42-2.77) and myalgias (DOR = 1.44; 95% CI, 1-2.08).
The traditional definition of influenza-like illness (ILI) — fever and cough and sore throat — and the combination of fever and cough, yielded similar sensitivity and specificity for predicting influenza. Among children aged 0 to 4 years, the addition of rhinorrhea increased the specificity compared with fever and cough alone.
“Utilizing these clinically relevant data elements for ILI detection may assist clinical providers in streamlining the influenza identification and treatment process and lead to expedited initiation of infection control measures and mobilization of public health resources to reduce influenza mortality and morbidity,” the researchers wrote. – by Emily Shafer
Disclosure: The researchers report no relevant financial disclosures.
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