Underdiagnosis of influenza virus infection in hospitalized older adults

Details

• Alternative Title:
  J Am Geriatr Soc
• Personal Author:
  Hartman, Lauren ; Zhu, Yuwei ; Edwards, Kathryn M. ; Griffin, Marie R. ; Talbot, H. Keipp
• Description:
  Objective ; To describe factors associated with provider-ordered influenza testing among hospitalized adults. ; Design ; Information on patient demographics, symptoms, and provider-ordered influenza testing were collected by questionnaire and chart review. We conducted prospective laboratory-based surveillance using reverse-transcriptase polymerase chain reaction (RT-PCR), the gold-standard for diagnosis of influenza, to determine how patient characteristics and provider-ordered testing impacted accurate influenza diagnosis. ; Setting ; One academic and three community hospitals in Davidson County, Tennessee, USA. ; Participants ; 1422 adults ages 18 years and older with acute respiratory illness or non-localizing fever. ; Measurements ; We compared characteristics of participants with and without provider-ordered testing for influenza using the Wilcoxon test and Pearson’s chi-square test. Multivariable logistic regression models identified factors predictive of provider-ordered influenza testing. ; Results ; Overall 28% (399/1422) of participants had provider-ordered influenza testing. Patients who were tested were younger than those not tested (58 ± 18 years vs. 66 ± 15 years, p < 0.001) and more likely to have influenza-like illness (ILI, 71% vs. 49%, p < 0.001). ILI increased with decreasing age: 48% ≥ 65 years; 60% 50–64 years; and 63% 18–49 years. Among all patients, presence of ILI and younger age were independent predictors of provider-ordered testing. Among the 136 patients with RT-PCR confirmed influenza, ILI was the only significant predictor of provider-ordered testing (AOR 3.43, 95% CI 1.22–9.70). ; Conclusion ; Adults 65 years and older hospitalized with fever or respiratory symptoms during influenza season are less likely to have a provider-ordered influenza test than younger adults. Some, but not all, of this disparity is due to a lower likelihood of ILI presentation. Further strategies are needed to increase clinician awareness and testing in this vulnerable group.
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• Subjects:
  • Article
  • influenza
  • elderly
  • older adults
• Source:
  J Am Geriatr Soc. 66(3):467-472
• Pubmed ID:
  29341100
• Pubmed Central ID:
  PMC5863754
• Document Type:
  Journal Article
• Funding:
  N01 AI025462/AI/NIAID NIH HHS/United States ; U18 IP000184/IP/NCIRD CDC HHS/United States ; N01AI25462/AI/NIAID NIH HHS/United States ; UL1 RR024975/RR/NCRR NIH HHS/United States ; R01 AG043419/AG/NIA NIH HHS/United States
• Volume:
  66
• Issue:
  3
• Download URL:
  https://stacks.cdc.gov/view/cdc/52767/cdc_52767_DS1.pdf
• File Type:
  [PDF - 87.58 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:668a301d58799c862c461cc6fc600e3700d4c499d1530f184408e7d5724f976b