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.
  
  
• Subjects:
  Article Elderly Influenza 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
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:668a301d58799c862c461cc6fc600e3700d4c499d1530f184408e7d5724f976b
• Download URL:
  https://stacks.cdc.gov/view/cdc/52767/cdc_52767_DS1.pdf
• File Type:
  [PDF - 87.58 KB ]