Evidence-based diagnosis of influenza

January 01, 0001

Evidence-based diagnosis of influenza

These US researchers looked at multivariate models and clinical decision rules to determine their use in diagnosing influenza. They performed a systematic review of MEDLINE, and also reviewed bibliographies of previous meta-analyses for studies examining the use of multivariate models, clinical decision rules, or diagnostic heuristics in influenza.

The researchers found: "A total of 12 studies met our inclusion criteria. No study prospectively validated a multivariate model or clinical decision rule, and no study performed a split-sample or bootstrap validation of such a model. Simple heuristics such as the so-called fever and cough rule and the fever, cough, and acute onset rule were each evaluated by several studies in populations of adults and children. The areas under the receiver operating characteristic curves were 0.70 and 0.79, respectively. We could not calculate a single summary estimate, however, as the diagnostic threshold varied among studies."

The researchers concluded: "The fever and cough, and the fever, cough, and acute onset heuristics have modest accuracy, but summary estimates could not be calculated. Further research is needed to develop and prospectively validate clinical decision rules to identify patients requiring testing, empiric treatment, or neither."

There is not currently an evidence-based clinical decision rule for diagnosing influenza beyond simple heuristics, so practitioners must depend on clinical judgement.

For the full abstract, click here.

Annals of Family Medicine 9(1):69-77, January 2011 © 2011 Annals of Family Medicine, Inc.
A Systematic Review of Clinical Decision Rules for the Diagnosis of Influenza. Mark H. Ebell and Anna Afonso. Correspondence to: Mark H. Ebell: [email protected]

Category: R. Respiratory. Keywords: influenza, diagnosis, clinical decision rules, multivariate model, heuristic, systematic review, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 18 February 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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