Field performance of clinical case definitions for influenza screening during the 2009 pandemic
Journal
American Journal of Emergency Medicine
Journal Volume
30
Journal Issue
9
Pages
1796-1803
Date Issued
2012
Author(s)
Abstract
Purpose: The aim of this study was to assess the performance of 3 different influenza-like illness (ILI) case definitions, adopted by the European (European-CDC), USA (USA-CDC), and Taiwan Centers for Disease Prevention and Control (Taiwan-CDC), as screening tools for influenza during the 2009 H1N1 pandemic. Methods: From August 15 to 30, 2009, all emergency department patients with clinical symptoms or at epidemiologic risk for influenza were enrolled in an observational cohort study. Influenza diagnosis was established by positive rapid influenza diagnostic test or virus isolation. Sensitivity, specificity, positive predictive value, and negative predictive value of the European-, USA, and Taiwan-CDC ILI case definitions for screening were determined. Results: A total of 870 patients were screened during the study period. Rapid influenza diagnostic test was positive in 315 patients, 273 (85.6%) of whom had fever duration less than 72 hours. Virus isolation identified 4 more patients with influenza A initially negative by rapid influenza diagnostic test. The mean (SD) age of these 319 patients was 24.3 (18.1) years. Of the 870 screened patients, 670 (77.0%), 476 (54.7%), and 325 (37.4%) met the European-, USA-, and Taiwan-CDC ILI case definition, respectively. Screening sensitivity was 95%, 77.7%, and 57.7% and specificity was 33.4%, 58.6%, and 74.4%, respectively. Differences in sensitivity and specificity between any 2 of the 3 groups were statistically significant (P <.05). Conclusion: First-line physicians should recognize the advantage and limitation of different ILI case definitions in influenza screening, especially confronted by pandemic or highly pathogenic avian influenza in the future. ? 2012 Elsevier Inc. All rights reserved.
SDGs
Other Subjects
influenza vaccine; oseltamivir; 2009 H1N1 influenza; adolescent; adult; antiviral therapy; article; child; chill; clinical assessment; clinical assessment tool; cohort analysis; controlled study; coughing; diagnostic test accuracy study; disease duration; dyspnea; emergency ward; epidemiological data; ethnic difference; ethnic group; Europe; female; fever; flu like syndrome; gastrointestinal symptom; human; immune function test; Influenza virus A H1N1; major clinical study; male; mortality; multicenter study; nose disease; observational study; predictive value; priority journal; prospective study; rapid influenza diagnostic test; risk factor; school child; screening test; sensitivity and specificity; sore throat; symptom; Taiwan; United States; virus isolation; Decision Support Techniques; Emergency Service, Hospital; Fever; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Male; Pandemics; Prospective Studies; Sensitivity and Specificity; Taiwan; Young Adult
Type
journal article