Predictors of influenza among older adults in the emergency department.

Autor: Lam PP; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. popo.lam@utoronto.ca.; Department of Microbiology, Mount Sinai Hospital, Toronto, ON, Canada. popo.lam@utoronto.ca., Coleman BL; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.; Department of Microbiology, Mount Sinai Hospital, Toronto, ON, Canada., Green K; Department of Microbiology, Mount Sinai Hospital, Toronto, ON, Canada.; Toronto Invasive Bacterial Diseases Network, Toronto, ON, Canada., Powis J; Toronto East General Hospital, Toronto, ON, Canada., Richardson D; William Osler Health System, Toronto, ON, Canada., Katz K; North York General Hospital, Toronto, ON, Canada., Borgundvaag B; Schwartz/Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, ON, Canada., Smith-Gorvie T; Department of Emergency Medicine, University Health Network, Toronto, ON, Canada., Kwong JC; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada., Bondy SJ; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada., McGeer A; 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.
Jazyk: angličtina
Zdroj: BMC infectious diseases [BMC Infect Dis] 2016 Oct 28; Vol. 16 (1), pp. 615. Date of Electronic Publication: 2016 Oct 28.
DOI: 10.1186/s12879-016-1966-4
Abstrakt: Background: Diagnosis 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.
Methods: We 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.
Results: Of 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).
Conclusions: As 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.
Databáze: MEDLINE
Externí odkaz: