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April 2004

Clinical Predictors of Influenza in Children

Author Affiliations

From the Department of Pediatrics, Division of Emergency Medicine, Alfred I. duPont Hospital for Children, Wilmington, Del; and Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pa. Dr Friedman is now with the Department of Pediatrics, Division of Emergency Medicine, Miami Children's Hospital, Miami, Fla.

Arch Pediatr Adolesc Med. 2004;158(4):391-394. doi:10.1001/archpedi.158.4.391

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.