Derivation and Validation of a Clinical Decision Guideline for Influenza Testing in 4 US Emergency Departments

Andrea F. Dugas, Yu Hsiang Hsieh, Frank Lovecchio, Gregory J. Moran, Mark T. Steele, David A. Talan, Richard E. Rothman, Amy Stubbs, Laurie Kemble, Danielle Beckham, Niccole Neal, Mary Mulrow, Anusha Krishnadasan, Kavitha Pathmarajah, Raquel Torrez, Eva Gonzalez, Gabina Martin, Noemi Quinteros Urzagaste, Jacklyn Furoy, Mayra HernandezClaire Collison, Anna Duval, Raphaelle Beard, Ama Avornu, Rebecca Medina, Breana McBryde

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)49-58
Number of pages10
JournalClinical Infectious Diseases
Volume70
Issue number1
DOIs
StatePublished - Jan 1 2020

Keywords

  • clinical decision guidelines
  • influenza
  • influenza-like illness (ILI)

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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    Dugas, A. F., Hsieh, Y. H., Lovecchio, F., Moran, G. J., Steele, M. T., Talan, D. A., Rothman, R. E., Stubbs, A., Kemble, L., Beckham, D., Neal, N., Mulrow, M., Krishnadasan, A., Pathmarajah, K., Torrez, R., Gonzalez, E., Martin, G., Urzagaste, N. Q., Furoy, J., ... McBryde, B. (2020). Derivation and Validation of a Clinical Decision Guideline for Influenza Testing in 4 US Emergency Departments. Clinical Infectious Diseases, 70(1), 49-58. https://doi.org/10.1093/cid/ciz171