Clinical predictors of influenza in children

Arch Pediatr Adolesc Med. 2004 Apr;158(4):391-4. doi: 10.1001/archpedi.158.4.391.


Background: It is difficult to diagnose influenza infection on clinical grounds alone. Available rapid diagnostic tests have limited sensitivities.

Objective: To develop a prediction model that identifies children likely to have influenza infection.

Design: Prospective study.

Setting: Emergency department of a children's hospital. Patients All patients with a febrile respiratory illness during the influenza season of winter 2002 were eligible. A prospective sample of 128 children who were suspected of having influenza infection based on predetermined criteria was enrolled. Each patient received a nasal wash for viral culture.

Main outcome measure: Clinical features that are most predictive of influenza infection in children.

Results: The mean +/- SD age of patients was 6.2 +/- 5.2 years; 50% were boys. Viral isolates included the following: influenza A, 45 patients (35%); influenza B, 13 (10%); other viruses, 10 (8%); negative results, 60 (47%). Demographic and clinical findings were not significantly different between the influenza A and influenza B groups. Cough (P =.003), headache (P =.04), and pharyngitis (P =.04) were independently associated with influenza infection. This triad used as a prediction model for influenza infection had a sensitivity of 80% (95% confidence interval [CI], 69%-91%); specificity, 78% (95% CI, 67%-89%); and likelihood ratio for a positive viral culture for influenza, 3.7 (95% CI, 2.3-6.3). The posttest probability of this clinical definition is 77% (95% CI, 63%-91%).

Conclusion: The triad of cough, headache, and pharyngitis is a predictor of influenza infection in children.

MeSH terms

  • Child
  • Cough / etiology
  • Female
  • Headache / etiology
  • Humans
  • Influenza A virus / isolation & purification
  • Influenza B virus / isolation & purification
  • Influenza, Human / diagnosis*
  • Likelihood Functions
  • Logistic Models
  • Male
  • Models, Theoretical
  • Pharyngitis / etiology
  • Predictive Value of Tests*
  • Prospective Studies
  • Sensitivity and Specificity