Clinical diagnosis of seasonal influenza by physicians: a retrospective observational study
Objective To elucidate the diagnostic accuracy of pretest probability of influenza (%) by physicians and the factors affecting the clinical diagnosis.Design Retrospective, single-centre observational study.Setting A community primary care clinic in Japan.Participants The participants were recruited...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/7/e055910.full |
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| author | Hiroyuki Kato Tadashi Kobayashi Hiroki Maita Takashi Akimoto Fumihiko Matsuoka Shigeki Funakoshi Hiroshi Osawa |
| author_facet | Hiroyuki Kato Tadashi Kobayashi Hiroki Maita Takashi Akimoto Fumihiko Matsuoka Shigeki Funakoshi Hiroshi Osawa |
| author_sort | Hiroyuki Kato |
| collection | DOAJ |
| description | Objective To elucidate the diagnostic accuracy of pretest probability of influenza (%) by physicians and the factors affecting the clinical diagnosis.Design Retrospective, single-centre observational study.Setting A community primary care clinic in Japan.Participants The participants were recruited from a database of studies conducted during the influenza season from December 2017 to April 2019.Primary outcome measure Sensitivity and specificity of the physician’s clinical diagnosis of influenza recorded in the medical record as pretest probability.Results A total of 335 patients (median age, 31 years; male, 66.6%) were analysed in this study. The area under the curve (AUC) of the physician’s pretest probability was 0.77. At a cut-off value of 30%, the sensitivity and negative likelihood ratio were 92.0% (95% CI 86.7 to 95.7) and 0.19 (95% CI 0.11 to 0.33), respectively. At a cut-off value of 80%, the specificity and positive likelihood ratio were 90.8% (95% CI 85.4 to 94.6) and 4.01 (95% CI 2.41 to 6.66), respectively. The AUCs of patients who had and had not taken any medications before visiting the clinic were 0.77 (95% CI 0.69 to 0.85) and 0.78 (95% CI 0.71 to 0.84), respectively. The AUCs of patients with type A and B influenza were 0.78 (95% CI 0.72 to 0.84) and 0.76 (95% CI 0.70 to 0.82), respectively. The AUCs of vaccinated and unvaccinated patients were 0.80 (95% CI 0.72 to 0.88) and 0.76 (95% CI 0.63 to 0.89), respectively. The AUC for patients less than 12 hours after onset was 0.69 (95% CI 0.51 to 0.88), and that for patients aged younger than 6 years was 0.69 (95% CI 0.49 to 0.88).Conclusions The physician’s pretest probability of influenza (%) may be useful for both definitive and exclusionary diagnoses within the limits of our study. |
| format | Article |
| id | doaj-art-3c8aa7942b5e4605aad4d25d83ad3bad |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-3c8aa7942b5e4605aad4d25d83ad3bad2025-01-31T08:45:10ZengBMJ Publishing GroupBMJ Open2044-60552022-07-0112710.1136/bmjopen-2021-055910Clinical diagnosis of seasonal influenza by physicians: a retrospective observational studyHiroyuki Kato0Tadashi Kobayashi1Hiroki Maita2Takashi Akimoto3Fumihiko Matsuoka4Shigeki Funakoshi5Hiroshi Osawa6Development of Community Healthcare, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, JapanDepartment of General Medicine, Hirosaki University School of Medicine and Hospital, Hirosaki, Aomori, JapanDevelopment of Community Healthcare, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, JapanDepartment of General Medicine, Hirosaki University School of Medicine and Hospital, Hirosaki, Aomori, JapanRokkasho Center for Community and Family Medicine, Rokkasho, Aomori, JapanRokkasho Center for Community and Family Medicine, Rokkasho, Aomori, JapanDepartment of General Medicine, Hirosaki University School of Medicine and Hospital, Hirosaki, Aomori, JapanObjective To elucidate the diagnostic accuracy of pretest probability of influenza (%) by physicians and the factors affecting the clinical diagnosis.Design Retrospective, single-centre observational study.Setting A community primary care clinic in Japan.Participants The participants were recruited from a database of studies conducted during the influenza season from December 2017 to April 2019.Primary outcome measure Sensitivity and specificity of the physician’s clinical diagnosis of influenza recorded in the medical record as pretest probability.Results A total of 335 patients (median age, 31 years; male, 66.6%) were analysed in this study. The area under the curve (AUC) of the physician’s pretest probability was 0.77. At a cut-off value of 30%, the sensitivity and negative likelihood ratio were 92.0% (95% CI 86.7 to 95.7) and 0.19 (95% CI 0.11 to 0.33), respectively. At a cut-off value of 80%, the specificity and positive likelihood ratio were 90.8% (95% CI 85.4 to 94.6) and 4.01 (95% CI 2.41 to 6.66), respectively. The AUCs of patients who had and had not taken any medications before visiting the clinic were 0.77 (95% CI 0.69 to 0.85) and 0.78 (95% CI 0.71 to 0.84), respectively. The AUCs of patients with type A and B influenza were 0.78 (95% CI 0.72 to 0.84) and 0.76 (95% CI 0.70 to 0.82), respectively. The AUCs of vaccinated and unvaccinated patients were 0.80 (95% CI 0.72 to 0.88) and 0.76 (95% CI 0.63 to 0.89), respectively. The AUC for patients less than 12 hours after onset was 0.69 (95% CI 0.51 to 0.88), and that for patients aged younger than 6 years was 0.69 (95% CI 0.49 to 0.88).Conclusions The physician’s pretest probability of influenza (%) may be useful for both definitive and exclusionary diagnoses within the limits of our study.https://bmjopen.bmj.com/content/12/7/e055910.full |
| spellingShingle | Hiroyuki Kato Tadashi Kobayashi Hiroki Maita Takashi Akimoto Fumihiko Matsuoka Shigeki Funakoshi Hiroshi Osawa Clinical diagnosis of seasonal influenza by physicians: a retrospective observational study BMJ Open |
| title | Clinical diagnosis of seasonal influenza by physicians: a retrospective observational study |
| title_full | Clinical diagnosis of seasonal influenza by physicians: a retrospective observational study |
| title_fullStr | Clinical diagnosis of seasonal influenza by physicians: a retrospective observational study |
| title_full_unstemmed | Clinical diagnosis of seasonal influenza by physicians: a retrospective observational study |
| title_short | Clinical diagnosis of seasonal influenza by physicians: a retrospective observational study |
| title_sort | clinical diagnosis of seasonal influenza by physicians a retrospective observational study |
| url | https://bmjopen.bmj.com/content/12/7/e055910.full |
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