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Development and validation of a clinical decision rule for the diagnosis of influenza.
MedLine Citation:
PMID:  22218625     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
METHODS: We combined data from 2 studies of influenza diagnosis in adult outpatients with suspected influenza: one set in California and one in Switzerland. Patients in both studies underwent a structured history and physical examination and had a reference standard test for influenza (polymerase chain reaction or culture). We randomly divided the dataset into derivation and validation groups and then evaluated simple heuristics and decision rules from previous studies and 3 rules based on our own multivariate analysis. Cutpoints for stratification of risk groups in each model were determined using the derivation group before evaluating them in the validation group. For each decision rule, the positive predictive value and likelihood ratio for influenza in low-, moderate-, and high-risk groups, and the percentage of patients allocated to each risk group, were reported.
RESULTS: The simple heuristics (fever and cough; fever, cough, and acute onset) were helpful when positive but not when negative. The most useful and accurate clinical rule assigned 2 points for fever plus cough, 2 points for myalgias, and 1 point each for duration <48 hours and chills or sweats. The risk of influenza was 8% for 0 to 2 points, 30% for 3 points, and 59% for 4 to 6 points; the rule performed similarly in derivation and validation groups. Approximately two-thirds of patients fell into the low- or high-risk group and would not require further diagnostic testing.
CONCLUSION: A simple, valid clinical rule can be used to guide point-of-care testing and empiric therapy for patients with suspected influenza.
Authors:
Mark H Ebell; Anna M Afonso; Ralph Gonzales; John Stein; Blaise Genton; Nicolas Senn
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American Board of Family Medicine : JABFM     Volume:  25     ISSN:  1557-2625     ISO Abbreviation:  J Am Board Fam Med     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-01-05     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101256526     Medline TA:  J Am Board Fam Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  55-62     Citation Subset:  IM    
Affiliation:
the Department of Epidemiology and Biostatistics and the Institute for Evidence-Based Health Professions Education, University of Georgia, Athens; the Department of Medicine, Division of General Internal Medicine and the Department of Emergency Medicine, University of California at San Francisco, San Francisco; the Infectious Disease Service and the Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland.
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