Background Timely and accurate diagnosis of influenza remains a challenge, but is critical for patients who may benefit from antiviral therapy. This study determined the test characteristics of provider diagnosis of influenza, final ED electronic medical record (EMR) diagnosis of influenza, and influenza like illness (ILI) in patients recommended to receive antiviral treatment according to Centers for Disease Control and Prevention (CDC) guidelines. Additionally, we evaluated the compliance with CDC antiviral guidelines. Methods A prospective cohort of adults presenting to a tertiary care ED with an acute respiratory illness who met CDC criteria for recommended antiviral treatment were enrolled and tested for influenza. A clinical diagnosis of influenza was assessed by asking the clinician: “Do you think this patient has influenza?” ILI was defined according to current CDC criteria. Results In this cohort of 270 subjects, 42 (16%; 95% CI 11-20%) had influenza. Clinician diagnosis had a sensitivity of 36% (95% CI 22-52%) and specificity of 78% (95%CI 72-83%); EMR final ED diagnosis had a sensitivity of 26% (95% CI 14-42%) and specificity of 97% (95% CI 94-99%); ILI had a sensitivity of 31% (95% CI 18-47%) and specificity of 88% (95% CI 83-92%). Only 15 (36%) influenza positive patients received antiviral treatment. Conclusion Clinician diagnosis, final ED EMR diagnosis and ILI have low sensitivity for diagnosing influenza, and there is overall poor compliance with CDC antiviral treatment recommendations. Improved methods of influenza diagnosis are needed to help guide management in the clinical setting.

Despite increasing MH-related presentations, changes in ED practice have allowed improvements in delivery of care through a shortened ED length of stay and the virtual elimination of very long stays over 24 h. However, there continues to be significant variability in management and performance across hospital sites. Identifying which interventions lead to standout site performance, and subsequent application more broadly, may improve future ED delivery of care.

No abstract

No abstract

No abstract

No abstract