Evaluation of clinical features scoring system as screening tool for influenza A (H1N1) in epidemic situations

J Postgrad Med. 2012 Oct-Dec;58(4):265-9. doi: 10.4103/0022-3859.105446.

Abstract

Background: Influenza A (H1N1) hit the headlines in recent times and created mass hysteria and general panic. The high cost and non-availability of diagnostic laboratory tests for swine flu, especially in the developing countries underlines the need of having a cheaper, easily available, yet reasonably accurate screening test.

Aims: This study was carried out to develop a clinical feature-based scoring system (CFSS) for influenza A (H1N1) and to evaluate its suitability as a screening tool when large numbers of influenza-like illness cases are suspect.

Settings and design: Clinical-record based study, carried out retrospectively in post-pandemic period on subject's case-sheets who had been quarantined at IG International Airport's quarantine center at Delhi.

Materials and methods: Clinical scoring of each suspected case was done by studying their case record sheet and compared with the results of RT-PCR. RT-PCR was used to confirm the diagnosis (Gold Standard).

Statistical analysis: We calculated sensitivity, specificity, positive and negative predictive values of the clinical feature-based scoring system (the proposed new screening tool) at different cut-off values. The most discriminant cut-off value was determined by plotting the ROC curve.

Results: Of the 638 suspected cases, 127 (20%) were confirmed to have H1N1 by RT-PCR examination. On the basis of ROC, the most discriminant clinical feature score for diagnosing Influenza A was found to be 7, which yielded sensitivity, specificity, positive, and negative predictive values of 86%, 88%, 64%, and 96%, respectively.

Conclusion: The clinical features scoring system (CFSS) can be used as a valid and cost-effective tool for screening swine flu (influenza A (H1N1)) cases from large number of influenza-like illness suspects.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Clinical Laboratory Techniques / methods*
  • Disease Outbreaks / prevention & control*
  • Double-Blind Method
  • Humans
  • India / epidemiology
  • Influenza A Virus, H1N1 Subtype / genetics
  • Influenza A Virus, H1N1 Subtype / isolation & purification*
  • Influenza, Human / diagnosis*
  • Influenza, Human / epidemiology
  • Influenza, Human / prevention & control
  • Mass Screening / methods*
  • Middle Aged
  • Observation
  • Reproducibility of Results
  • Retrospective Studies
  • Reverse Transcriptase Polymerase Chain Reaction
  • Sensitivity and Specificity
  • Travel
  • Young Adult