"Diagnosis, Treatment, and Impact on Function of Influenza in a College Health Population"
Dale, Ariella Perry
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Problem: Studies of influenza in the college health population are primarily focused on outbreaks such as H1N1 in 2009. Our goal is to better understand the diagnosis, treatment, and impact of influenza in college students during a traditional influenza season. Methods: A quasi-experimental study at the University of Georgia Health Center from December 2016 to February 2017. Patients with a cough and at least one influenza-like symptom received a rapid PCR test for the diagnosis of influenza and were sent a follow up survey. A systematic review was conducted on the clinical decision rules (CDR) for the diagnosis of influenza which were validated in our population and a novel CDR was developed. The impact of PCR-guided care and PCR-confirmed diagnosis on treatment and behavior were also assessed. Results: A total of 265 patients were recruited during enrollment and 771 patients met our inclusion but did not receive the rapid PCR test were assigned as usual care. The systematic review yielded 16 studies that had five heuristics, 12 multivariate models, four influenza-like-illness case definitions, four classification and regression trees, and one-point score. Twelve CDRs were externally validated in our population. A CDR including myalgia, chills, fever, and the absence of tonsillar exudate as predictors of influenza performed well. (AUROCC: 0.77). A fast and frugal tree yielded a CDR with myalgia, chills, fever, and acute onset of less than or equal to 48 hours (AUROCC: 0.69). Guideline supported care did not significantly increase for patients who received PCR-guided care (aOR: 1.24, 95%CI: 0.83, 1.88). PCR-guided care significantly decreased the likelihood of an antibiotic prescription (aOR: 0.61, 95%CI: 0.40, 0.94), increased the likelihood of an antiviral prescription (aOR: 1.57, 95%ci: 1.09, 2.28), and decreased the likelihood of return visit within 2 weeks (aOR: 0.19, 95%CI: 0.04, 0.81). Students with influenza were also more likely to report any absence from work or school (aOR: 3.86; 95% CI: 1.84,8.09). Conclusion: Influenza remains a burden in the college health population. The use of a rapid PCR test for diagnosis in outpatient care needs further assessment but shows a positive trend towards in promoting guideline consistent care.