Emergency Department Diagnosis and Managment of Influenza

Influenza;emergency medicine;antivirals;not listed

Dugas, Andrea Suzanne FreyerDiener-West, Marie ;

Johns Hopkins University

关键词: Influenza;    emergency medicine;    antivirals;    not listed;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/44600/DUGAS-DISSERTATION-2014.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Introduction: Diagnosing influenza in the emergency department (ED) remains a challenge as physicians have no reliable tools to accurately and rapidly diagnose influenza; however, rapid diagnosis is crucial to begin antiviral therapy in patients with complications or at risk of complications from influenza.Centers for Disease Control and Prevention (CDC) Guidelines recommend prompt antiviral treatment for patients who are hospitalized, at extremes of age (<5 years old, >65 years old), or have a chronic disease or conditions putting them at increased risk of complications.Methods: First, we determined compliance with CDC antiviral guidelines via a retrospective evaluation of ED patients with confirmed influenza.Then, we created a prospective cohort of ED patients who met CDC criteria for recommended antiviral treatment who were evaluated for influenza by 3 means: clinical diagnosis, a new molecular-based rapid test, and a Polymerase Chain Reaction (PCR) test.Comparing the clinical diagnosis and rapid influenza test to the standard PCR assay allowed for a performance evaluation of both clinician diagnosis, and the new molecular-based rapid test.Finally, a cost-effectiveness analysis was performed to compare influenza testing and treatment strategies.Results: ED providers have poor compliance with CDC guidelines regarding antiviral treatment with only 41% of patients recommended to receive antiviral treatment being treated in the ED.Provider diagnosis for influenza has a poor sensitivity of 36%, especially compared to the molecular-based rapid influenza test which has 95% sensitivity in the same population.Finally, the most cost-effective testing and treatment strategy depends on influenza prevalence with rapid testing as the most cost-effective treatment at low influenza prevalence, and treating all patients without testing as the most cost-effective strategy at high prevalence.Conclusions: The challenges of making a clinical diagnosis of influenza in the ED, and current lack of a rapid sensitive influenza test, likely contribute to poor compliance with current CDC guidelines regarding antiviral administration.Integrating a new highly sensitive molecular-based rapid influenza test into ED clinical care, could improve compliance with CDC guidelines and is cost effective at low influenza prevalence.