Journal article
Derivation and Validation of a Clinical Decision Guideline for Influenza Testing in 4 US Emergency Departments
Clinical infectious diseases, Vol.70(1), pp.49-58
01/01/2020
DOI: 10.1093/cid/ciz171
PMID: 30843056
Abstract
An accurate diagnosis of influenza is essential for appropriate antiviral treatment, in accordance with Centers for Disease Control and Prevention (CDC) guidelines. However, no clear guidance exists on which patients should be tested. We sought to develop a clinical decision guideline (CDG) to inform influenza testing decisions for those adult emergency department (ED) patients deemed appropriate for antiviral treatment by CDC guidelines.
A prospective cohort study was performed at 4 US EDs. From November 2013 to April 2014, we enrolled adult ED patients with fever or respiratory symptoms who met criteria for antiviral treatment, per 2013 CDC guidelines. All patients were tested for influenza using polymerase chain reaction. Data were randomly split into derivation (80%) and validation (20%) data sets. A discrete set of independent variables was selected by logistic regression, using the derivation set to create a scoring system, with a target sensitivity of at least 90%. The derived CDG was then validated.
Of 1941 enrolled participants, 183 (9.4%) had influenza. The derived CDG included new or increased cough (2 points), headache (1 point), subjective fever (1 point), and triage temperature >100.4°C (1 point), with a score of ≥3 indicating influenza testing was warranted. The CDG had a sensitivity and specificity of 94.1% and 36.6%, respectively, in the derivation set and of 91.5% and 34.6%, respectively, in the validation set.
A CDG with high sensitivity was derived and validated. Incorporation into practice could standardize testing for high-risk patients in adult EDs during influenza seasons, potentially improving diagnoses and treatment.
NCT01947049.
Details
- Title: Subtitle
- Derivation and Validation of a Clinical Decision Guideline for Influenza Testing in 4 US Emergency Departments
- Creators
- Andrea F Dugas - Johns Hopkins MedicineYu-Hsiang Hsieh - Johns Hopkins MedicineFrank LoVecchio - University of ArizonaGregory J Moran - Olive View-UCLA Medical CenterMark T Steele - Truman Medical CenterDavid A Talan - Olive View-UCLA Medical CenterRichard E Rothman - Johns Hopkins MedicineEmergency Department National Influenza Network Investigators
- Resource Type
- Journal article
- Publication Details
- Clinical infectious diseases, Vol.70(1), pp.49-58
- DOI
- 10.1093/cid/ciz171
- PMID
- 30843056
- ISSN
- 1058-4838
- eISSN
- 1537-6591
- Grant note
- R01 HS009699 / AHRQ HHS U01 CI000353 / NCPDCID CDC HHS U01 CK000176 / NCEZID CDC HHS
- Language
- English
- Date published
- 01/01/2020
- Academic Unit
- Emergency Medicine; Internal Medicine
- Record Identifier
- 9984296985002771
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