Clinical diagnosis of influenza in the ED
Open accessAbstract
Background Timely and accurate diagnosis of influenza remains a challenge but is critical for patients who may benefit from antiviral therapy. This study determined the test characteristics of provider diagnosis of influenza, final ED electronic medical record (EMR) diagnosis of influenza, and influenza-like illness (ILI) in patients recommended to receive antiviral treatment according to Centers for Disease Control and Prevention (CDC) guidelines. In addition, we evaluated the compliance with CDC antiviral guidelines.Methods A prospective cohort of adults presenting to a tertiary care ED with an acute respiratory illness who met CDC criteria for recommended antiviral treatment were enrolled and tested for influenza. A clinical diagnosis of influenza was assessed by asking the clinician: "Do you think this patient has influenza?" Influenza-like illness was defined according to current CDC criteria.Results In this cohort of 270 subjects, 42 (16%; 95% confidence interval [CI], 11%-20%) had influenza. Clinician diagnosis had a sensitivity of 36% (95% CI, 22%-52%) and specificity of 78% (95% CI, 72%-83%); EMR final ED diagnosis had a sensitivity of 26% (95% CI, 14%-42%) and specificity of 97% (95% CI, 94%-99%); ILI had a sensitivity of 31% (95% CI, 18%-47%) and specificity of 88% (95% CI, 83%-92%). Only 15 influenza-positive patients (36%) received antiviral treatment.Conclusion Clinician diagnosis, final ED EMR diagnosis, and ILI have low sensitivity for diagnosing influenza, and there is overall poor compliance with CDC antiviral treatment recommendations. Improved methods of influenza diagnosis are needed to help guide management in the clinical setting.
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Patients admitted to hospital with influenza are more likely to receive antibiotics than antiviral medications.
“However, as previous observational studies have shown, patients admitted to the hospital with influenza are more likely to receive antibiotics than antiviral medications.59, 60”
From The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. (2016) · cites this paper as [60]
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Point-of-Care Testing for Influenza
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CIRCULATING PATTERN OF RESPIRATORY VIRUSES, IN EGYPT, SEASON 2013-2014
Roshdy, W. H., Naguib, A. M., El-Sayed, I. H., & Shamikh, Y. I. (2020) · Bulletin of Pharmaceutical Sciences Assiut · doi:10.21608/bfsa.2020.127419 · Cited by 3 · see citing works
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AKASH, Y., Suzuki, H., TAKEUCH, Y., Atsuo, U. E. D. A., Hirose, Y., Imai, H., & Ishikawa, H. (2021) · Kansenshogaku zasshi · doi:10.11150/kansenshogakuzasshi.95.9 · Cited by 2 · see citing works
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Clinical diagnosis of seasonal influenza by physicians: a retrospective observational study
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Inactivated and Recombinant Influenza Vaccines
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“In similar studies, the rate of antiviral therapy initiation changed between 12% and 41% in patients who were positive for influenza virus [11,14,24], and the low rates of antiviral therapy might be because of the low frequency of the diagnostic test use for influenza.”
BackgroundEhrhard, S., Herren, L., Ricklin, M. E., Suter‐Riniker, F., Exadaktylos, A. K., Hautz, W. E., Müller, M., & Jent, P. (2024) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofae242 · Cited by 1 · see citing works
“Common syndromal case definitions, however, have poor sensitivity and specificity to diagnose influenza [1–3].”
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Invited Product Profile – Cobas Liat System
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“Influenza viruses cause annual epidemics typically between November andMarch in the northern hemisphere(1) and are responsible for 3000 to 49,000 deaths in the United States each year.(2) Respiratory syncytial virus is the most common cause of bronchiolitis and pneumonia, with most individuals recovering in a week or…”
BackgroundInvited Product Profile – GeneXpert Xpress System for Respiratory Testing
Baron, E. J., & Persing, D. H. (2019) · Point of Care The Journal of Near-Patient Testing & Technology · doi:10.1097/poc.0000000000000187 · Cited by 1 · see citing works
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“Michiels et al encontraron una prevalencia de gripe del 52% [13] y en otro estudio efectuado en un departamento de emergencias, del 42% [14].”
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Self-citationAvian influenza: H7N9, H5N1 and other novel strains
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Out With the Old, In With the Flu
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Introduction of respiratory viruses point of care testing at multi-site front-door admission wards
Abbas, A., Okoliegbe, I. N., & Sakka, N. E. (2026) · Infection Prevention in Practice · doi:10.1016/j.infpip.2026.100587
- Authors
- Dugas, A. F., Valsamakis, A., Atreya, M. R., Thind, K., Alarcon Manchego, P., Faisal, A., Gaydos, C. A., & Rothman, R. E.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Dugas, Andrea F.
- Venue
- The American Journal of Emergency Medicine
- Publisher
- Elsevier BV
- Published
- 2015-06
- Volume
- 33
- Issue
- 6
- Pages
- 770-775
- ISSN
- 0735-6757 (ISSN-L)
- PMC
- PMC4458223
- OpenAlex
- W1859522205
- Cited by
- 74
- References
- 19
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 5 · 2023: 3 · 2022: 4 · 2021: 12 · 2020: 8 · 2019: 10 · 2018: 9 · 2017: 7 · 2016: 8 · 2015: 4
- FWCI
- 7.32
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The American Journal of Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Johns Hopkins University
- Centers for Disease Control and Prevention
- National Institute of Allergy and Infectious Diseases (HHSN272201400007C)
- National Center for Research Resources (KL2RR025006)
- Topics
- Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
- Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- influenza diagnosis, diagnosis, influenza-like illness, antiviral therapy, guideline adherence, sensitivity and specificity, acute respiratory illness, emergency department
- MeSH terms
- Adult, Diagnosis, Differential, Emergency Service, Hospital, Female, Hospitals, Urban, Humans, Influenza, Human, Male, Middle Aged, Prospective Studies, Sensitivity and Specificity, Electronic Health Records
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