TY - JOUR
T1 - Derivation and Validation of a Clinical Decision Guideline for Influenza Testing in 4 US Emergency Departments
AU - Dugas, Andrea F.
AU - Hsieh, Yu Hsiang
AU - Lovecchio, Frank
AU - Moran, Gregory J.
AU - Steele, Mark T.
AU - Talan, David A.
AU - Rothman, Richard E.
AU - Stubbs, Amy
AU - Kemble, Laurie
AU - Beckham, Danielle
AU - Neal, Niccole
AU - Mulrow, Mary
AU - Krishnadasan, Anusha
AU - Pathmarajah, Kavitha
AU - Torrez, Raquel
AU - Gonzalez, Eva
AU - Martin, Gabina
AU - Urzagaste, Noemi Quinteros
AU - Furoy, Jacklyn
AU - Hernandez, Mayra
AU - Collison, Claire
AU - Duval, Anna
AU - Beard, Raphaelle
AU - Avornu, Ama
AU - Medina, Rebecca
AU - McBryde, Breana
N1 - Publisher Copyright:
© 2019 The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Background: 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. Methods: 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. Results: 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. Conclusions: 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. Clinical Trial Registration: NCT01947049.
AB - Background: 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. Methods: 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. Results: 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. Conclusions: 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. Clinical Trial Registration: NCT01947049.
KW - clinical decision guidelines
KW - influenza
KW - influenza-like illness (ILI)
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U2 - 10.1093/cid/ciz171
DO - 10.1093/cid/ciz171
M3 - Article
C2 - 30843056
AN - SCOPUS:85066414675
SN - 1058-4838
VL - 70
SP - 49
EP - 58
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 1
ER -