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Rapid Molecular Detection and Differentiation of Influenza Viruses A and B
Published on: January 30, 2017
Clinical predictors of influenza in children
Marla J Friedman1, Magdy W Attia
1Department of Pediatrics, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA. marla.friedman@mch.com
Insights
A simple clinical prediction model using cough, headache, and pharyngitis can help identify children with influenza infection, improving diagnosis when rapid tests are unreliable.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Epidemiology
- Diagnostic Accuracy Studies
Background:
- Diagnosing influenza in children clinically is challenging due to overlapping symptoms with other febrile respiratory illnesses.
- Rapid diagnostic tests for influenza often exhibit limited sensitivity, potentially leading to missed diagnoses.
Purpose of the Study:
- To develop and validate a clinical prediction model for identifying children with influenza infection.
- To improve the diagnostic accuracy of influenza in pediatric patients presenting with febrile respiratory illness.
Main Methods:
- A prospective study was conducted in a children's hospital emergency department during the influenza season.
- 128 children with suspected influenza infection were enrolled, undergoing nasal wash for viral culture.
- Clinical features were analyzed to identify those independently associated with confirmed influenza infection.
Main Results:
- Influenza A was detected in 35% and influenza B in 10% of the children.
- Cough, headache, and pharyngitis were independently associated with influenza infection (P=.003, P=.04, P=.04, respectively).
- The triad of cough, headache, and pharyngitis demonstrated 80% sensitivity and 78% specificity for influenza infection.
Conclusions:
- The combination of cough, headache, and pharyngitis serves as a valuable clinical predictor for influenza in children.
- This symptom triad can aid clinicians in suspecting influenza, especially when rapid test results are inconclusive.
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 hospital. Patients 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.
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