Clinical prediction rules combining signs, symptoms and epidemiological context to distinguish influenza from influenza-like illnesses in primary care: a cross sectional study
Clinical prediction rules combining signs, symptoms and epidemiological context to distinguish influenza from influenza-like illnesses in primary care: a cross sectional study
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DOI：
10.1186/1471-2296-12-4
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发表时间：
2011-02-09
影响因子：
2.9
通讯作者：
Coenen, Samuel
中科院分区：
文献类型：
--
作者：
Michiels, Barbara;Thomas, Isabelle;Coenen, Samuel
背景：在流感流行期间，迅速诊断出流感很重要。但是，这种诊断基本上基于全科医生对症状和体征的解释。没有一个症状足够特异性，可以在将流感与其他呼吸道感染区分开。我们的目标是制定诊断流感的预测规则，并具有最佳的诊断表现，结合了类似流感的类似流感的疾病的症状，体征和背景。鼻腔和口咽拭子）4597例流感样疾病（ILI）的患者，并注册了其症状和体征，一般特征和上下文信息。通过Directigenflu-A＆B和RT-PCR测试对样品进行了分析。 4584记录对于进一步分析很有用。从广义估计方程（GEE）模型中最相关的变量开始，我们计算了接收器操作特征曲线（ROC AUC）下的面积，阳性（LR+）和负测试结果（LR-）的敏感性，特异性和可能性比率（LR-）在测试前和测试后的赔率中，单个和组合的体征，症状和上下文。流感病毒的样品的阳性：64％（2066/3212），在25％（343/1372）pre/tof the流感流行前。在/预/邮寄流感流行期间，“以前的流感般的接触”，“咳嗽”，“疾病第一天的期望”和“体温高于37.8摄氏度”的LR+为3.35（95％CI 2.67-4.4.03 ）和1.34（95％CI 0.97-1.72）。在/预/之前，流感流行病的流行病“咳嗽”和“体温高于37.8度C”的体温为0.34（95％CI 0.27-0.41）和0.07（95％CI 0.05-0.08）。使用临床和上下文信息排除流感比统治它更容易。咳嗽和发烧（> 37.8摄氏度）的流感率降低了ILI患者的14倍。在流行病中，“以前的流感样接触”，咳嗽，“疾病第一天的期望”和发烧（> 37.8摄氏度）增加了流感三倍的流感可能性。快速护理测试的额外诊断价值尤其是确认流感的仍然必须建立。
Background: During an influenza epidemic prompt diagnosis of influenza is important. This diagnosis however is still essentially based on the interpretation of symptoms and signs by general practitioners. No single symptom is specific enough to be useful in differentiating influenza from other respiratory infections. Our objective is to formulate prediction rules for the diagnosis of influenza with the best diagnostic performance, combining symptoms, signs and context among patients with influenza-like illness.Methods: During five consecutive winter periods (2002-2007) 138 sentinel general practitioners sampled (naso- and oropharyngeal swabs) 4597 patients with an influenza-like illness (ILI) and registered their symptoms and signs, general characteristics and contextual information. The samples were analysed by a DirectigenFlu-A&B and RT-PCR tests. 4584 records were useful for further analysis. Starting from the most relevant variables in a Generalized Estimating Equations (GEE) model, we calculated the area under the Receiver Operating Characteristic curve (ROC AUC), sensitivity, specificity and likelihood ratios for positive (LR+) and negative test results (LR-) of single and combined signs, symptoms and context taking into account pre-test and post-test odds.Results: In total 52.6% (2409/4584) of the samples were positive for influenza virus: 64% (2066/3212) during and 25% (343/1372) pre/post an influenza epidemic. During and pre/post an influenza epidemic the LR+ of 'previous flu-like contacts', 'coughing', 'expectoration on the first day of illness' and 'body temperature above 37.8 degrees C' is 3.35 (95% CI 2.67-4.03) and 1.34 (95% CI 0.97-1.72), respectively. During and pre/post an influenza epidemic the LR-of 'coughing' and 'a body temperature above 37.8 degrees C' is 0.34 (95% CI 0.27-0.41) and 0.07 (95% CI 0.05-0.08), respectively.Conclusions: Ruling out influenza using clinical and contextual information is easier than ruling it in. Outside an influenza epidemic the absence of cough and fever (> 37.8 degrees C) makes influenza 14 times less likely in ILI patients. During an epidemic the presence of 'previous flu-like contacts', cough, 'expectoration on the first day of illness' and fever (> 37.8 degrees C) increases the likelihood for influenza threefold. The additional diagnostic value of rapid point of care tests especially for confirming influenza still has to be established.