Article Figures & Data
Tables
- Table 1.
Design Characteristics of Included Studies (All Were Cohort and Independent, with Blinding Not Explicitly Stated)
Study Setting Influenza n Population Reference Standard Inclusion Criteria Nicholson et al 199710 Community A or B 291 Mean age, 73 years; 51.8% female 4× rise in titer for Influenza A Respiratory infection (over age 60) Carrat et al, 199712 Primary care office and home visit A or B 130 Mean age, 33.2 years; 59% female Fluorescent monoclonal antibodies Suspected influenza (influenza-like illness, upper or lower respiratory tract infection, and/or fever >38 without other evidence of infection within 36 hours of onset) Carrat et al, 19999 Primary care office and home visits A 600 Mean age, 38 years; 58% female DIF and ELISA; 25% culture + PCR Suspected influenza (all patients over age 1 with ≥1 of the following: influenza-like illness, upper or lower respiratory tract infectious syndrome, and/or temp >38°C without any infectious signs or symptoms.) Monto et al, 199611 Primary care office A or B 897 NA Viral culture or positive serology Suspected influenza (influenza-like illness with fever and cough or sore throat presenting between November and April) Lina et al, 199613 Primary care office A or B 340 NA (broad age range) Culture or ELISA Suspected influenza; data not available for patients without positive viral nasal swab. Long et al, 199714 Primary care office A or B 788 Mean age, 76 in adults, 5 in children Tissue culture, with ELISA to type the virus Adults over age 65 and children with respiratory or febrile illness in community medical and pediatric practices. Monto et al, 20008 Outpatient A or B 3744 Mean age, 34.7 years; 52% female. Positive culture or ≥4× increase in influenza antibody titer in convalescent vs acute samples Suspected influenza [fever (≥37.8°C; ≥37.2°C for patients ≥65 years in one study) or feverishness (subjective fever or chills) and 2 of the following: headache, myalgia, cough, or sore throat]. DIF, direct immunofluorescence; ELISA, enzyme-linked immunosorbent assay; NA, not available
Variable n Sens Spec LR+ LR− Weighted AUROCC Abdominal pain 0.17 0.88 1.46 0.94 Variables with LR+ >2.0 and/or LR− < 0.5 Rigors (10) 291 0.16 0.98 7.16 0.86 NA Fever and ≥3 days ill (age >65) (8) 677 0.40 0.90 4.03 0.67 NA Sweating (10) 291 0.47 0.83 2.86 0.63 NA Fever and cough >36 hours (8) 3744 0.50 0.81 2.64 0.61 NA Confined to bed (10) 291 0.63 0.74 2.45 0.50 NA Smoker (10) 291 0.32 0.87 2.39 0.79 NA Unable to cope with daily activities (10) 291 0.74 0.68 2.30 0.39 NA Fever + cough + nasal congestion (8) 3744 0.59 0.74 2.27 0.55 NA Fever + cough + weakness (8 3744 0.60 0.72 2.10 0.56 NA Any systemic symptom (10) 291 0.84 0.43 1.49 0.36 NA Cough (8, 9, 11, 13) 0.88 (0.72 to 0.96) 0.32 (0.17 to 0.52) 1.29 0.38 0.679 Commonly measured variables with LR+ <2.0 and LR− >0.5 Chills (9, 11) 1497 0.83 (0.79 to 0.86) 0.25 (0.22 to 0.27) 1.11 0.68 NA Subjective temp (8, 10, 11, 14) 5720 0.68 (0.62 to 0.72) 0.60 (0.43 to 0.75) 1.7 0.53 0.672 Objective temp (8, 9, 13) 4684 0.70 (0.46 to 0.86) 0.49 (0.29 to 0.69) 1.37 0.61 0.653 Headache (8, 9, 10, 11, 13) 5872 0.77 (0.65 to 0.86) 0.39 (0.23 to 0.58) 1.26 0.59 0.606 Myalgia (8, 10, 11, 13) 5272 0.68 (0.57 to 0.77) 0.47 (0.18 to 0.78) 1.26 0.60 0.620 Nasal congestion (8, 10, 11) 4932 0.70 (0.56 to 0.81) 0.42 (0.23 to 0.63) 1.21 0.71 0.654 Nasal secretions (purulent) (10, 13) 631 0.17 (0.04 to 0.48) 0.79 (0.63 to 0.89) 0.81 1.05 0.613 No sneezing (9, 10) 891 0.56 (0.39 to 0.72) 0.53 (0.31 to 0.74) 1.19 0.83 0.555 Not vaccinated (12, 14) 912 0.69 (0.19 to 0.96) 0.30 (0.02 to 0.89) 0.98 1.03 0.534 Sore throat (8, 10, 11, 13) 5272 0.68 (0.61 to 0.74) 0.36 (0.26 to 0.47) 1.06 0.89 0.558 Sputum (9, 11) 1497 0.36 (0.25 to 0.48) 0.68 (0.43 to 0.86) 1.13 0.94 0.450 NA, not applicable because there was only one study; n, number of patients; AUROCC, area under the receiver operating characteristic curve.
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Supplemental Table. Complete Data for Meta-Analysis, Organized by Type of Influenza
Supplemental Table. Complete Data for Meta-Analysis, Organized by Type of Influenza
Files in this Data Supplement:
- Adobe PDF - meta_analyses.pdf - Supplemental Table. Complete Data for Meta-Analysis, Organized by Type of Influenza
A Systematic Review of the History and Physical Examination to Diagnose Influenza
