Clinical predictors of influenza in children
Clinical predictors of influenza in children
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DOI：
10.1001/archpedi.158.4.391
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发表时间：
2004-04-01
影响因子：
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通讯作者：
Attia, MW
中科院分区：
文献类型：
--
作者：
Friedman, MJ;Attia, MW
背景：单凭临床诊断流感感染是困难的。可用的快速诊断测试有有限的sensitivity.Objective：开发一个预测模型，确定儿童可能有流感infection.Design：前瞻性研究。设置：急诊科的儿童hospitalPatients：所有患者在2002年冬季流感季节发热性呼吸道疾病是合格的。根据预先确定的标准，招募了128名疑似流感感染儿童的前瞻性样本。每个病人都接受了洗鼻液进行病毒培养。主要结果测量：最能预测儿童流感感染的临床特征。结果：病人的平均+/-SD年龄为6.2+/-5.2岁; 50%为男孩。病毒分离株包括：甲型流感，45例患者（35%）;乙型流感B，13例（10%）;其他病毒，10例（8%）;阴性结果，60例（47%）。甲型流感和乙型流感B组之间的人口统计学和临床结果无显著差异。咳嗽（P= 0.003）、头痛（P= 0.04）和咽炎（P= 0.04）与流感感染独立相关。该三联体用作流感感染的预测模型，灵敏度为80%（95%置信区间[CI]，69%-91%）;特异性为78%（95% CI，67%-89%）;流感病毒培养阳性的似然比为3.7（95% CI，2.3-6.3）。结论：咳嗽、头痛、咽炎三联征是儿童流感感染的预测因子。
Background: It is difficult to diagnose influenza infection on clinical grounds alone. Available rapid diagnostic tests have limited sensitivities.Objective: To develop a prediction model that identifies children likely to have influenza infection.Design: Prospective study.Setting: Emergency department of a children's hospitalPatients: All patients with a febrile respiratory illness during the influenza season of winter 2002 were eligible. A prospective sample of 128 children who were suspected of having influenza infection based on predetermined criteria was enrolled. Each patient received a nasal wash for viral culture.Main Outcome Measure: Clinical features that are most predictive of influenza infection in children.Results: The mean+/-SD age of patients was 6.2+/-5.2 years; 50% were boys. Viral isolates included the following: influenza A, 45 patients (35%); influenza B, 13 (10%); other viruses, 10 (8%); negative results, 60 (47%). Demographic and clinical findings were not significantly different between the influenza A and influenza B groups. Cough (P=.003), headache (P=.04), and pharyngitis (P=.04) were independently associated with influenza infection. This triad used as a prediction model for influenza infection had a sensitivity of 80% (95% confidence interval [CI], 69%-91%); specificity, 78% (95% CI, 67%-89%); and likelihood ratio for a positive viral culture for influenza, 3.7 (95% CI, 2.3-6.3). The posttest probability of this clinical definition is 77% (95% CI, 63%-91%).Conclusion: The triad of cough, headache, and pharyngitis is a predictor of influenza infection in children.