Predictors of influenza among older adults in the emergency department

BMC Infectious Diseases

Research Article

Susan J. Bondy¹  Po-Po Lam²  Brenda L. Coleman²  Allison McGeer³  Telisha Smith-Gorvie⁴  Karen Green⁵  Jeffrey C. Kwong⁶  Kevin Katz⁷  Bjug Borgundvaag⁸  Jeff Powis⁹  David Richardson^1,10 

[1] Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada;Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada;Department of Microbiology, Mount Sinai Hospital, Toronto, ON, Canada;Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada;Department of Microbiology, Mount Sinai Hospital, Toronto, ON, Canada;Toronto Invasive Bacterial Diseases Network, Toronto, ON, Canada;Department of Emergency Medicine, University Health Network, Toronto, ON, Canada;Department of Microbiology, Mount Sinai Hospital, Toronto, ON, Canada;Toronto Invasive Bacterial Diseases Network, Toronto, ON, Canada;Institute for Clinical Evaluative Sciences, Toronto, ON, Canada;North York General Hospital, Toronto, ON, Canada;Schwartz/Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, ON, Canada;Toronto East General Hospital, Toronto, ON, Canada;William Osler Health System, Toronto, ON, Canada;

关键词: Influenza;    Older adults;    Elderly;    Clinical symptoms;   

DOI  :  10.1186/s12879-016-1966-4

 received in 2016-03-08, accepted in 2016-10-25,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundDiagnosis of influenza in older adults may be complicated by atypical presentations or when patients present with complications of an underlying illness. We aimed to identify clinical characteristics and epidemiological factors associated with influenza among community-dwelling adults aged ≥60 years presenting to emergency departments.MethodsWe identified patients with influenza-compatible chief complaints presenting to emergency departments of six acute care hospitals in Ontario, Canada during the 2011/12 and 2012/13 influenza seasons. Clinical characteristics, medical history and demographics were collected by patient interview, chart review and by contacting vaccine providers. Nasopharyngeal swabs were tested for influenza using polymerase chain reaction. We modeled predictors of influenza using multivariable logistic regression models that compared individuals with and without influenza.ResultsOf 1318 participants, 151 (11 %) had influenza (98 A/H3N2, 12 A/H1N1, 4 A [not sub-typed], 37 B). In the multivariable model, clinical symptoms associated with influenza were cough (OR 6.4, 95 % CI 3.2, 13.0), feverishness and/or triage temperature ≥37.2 °C (OR 3.0, 95 % CI 2.0, 4.7), 2–5 days from symptom onset to the emergency department visit (OR 2.2, 95 % CI 1.5, 3.2), and wheezing (OR 2.1, 95 % CI 1.3, 3.3). The effect of cough on influenza increased with older age. Epidemiological factors associated with increased odds for influenza included weeks when ≥10 % influenza tests from provincial laboratories were positive (OR 5.1, 95 % CI 1.2, 21.7) and exposure to a person with influenza-like illness (OR 1.9, 95 % CI 1.3, 2.8). Among participants with influenza, only 47 (31 %) met the U.S. Centers for Disease Control and Prevention criteria for influenza-like illness (temperature ≥37.8 °C and cough and/or sore throat).ConclusionsAs in younger adults, cough and feverishness are the two symptoms most predictive of influenza in the elderly. Current influenza-like illness definitions did not adequately capture influenza in older adults.

【 授权许可】

CC BY   
© The Author(s). 2016