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Review
. 2023 Dec 3;10(1):e23227.
doi: 10.1016/j.heliyon.2023.e23227. eCollection 2024 Jan 15.

A systematic review of tools for predicting complications in patients with influenza-like illness

Tania Marx  1 , Nada Khelifi  1 , Isabelle Xu  1 , Laurie Ouellet  1 , Annie Poirier  1 , Benoit Huard  1 , Myriam Mallet  1 , Frédéric Bergeron  2 , Maurice Boissinot  3 , Michel G Bergeron  3 , Simon Berthelot  1   4
Affiliations
Review

A systematic review of tools for predicting complications in patients with influenza-like illness

Tania Marx et al. Heliyon. .

Abstract

Objective: To identify tools that predict the risk of complications for patients presenting to an outpatient clinic or an emergency department (ED) with influenza-like illness.

Methods: We searched Medline, Embase, Cochrane Library and CINAHL from inception to July 2023. We included articles reporting on the derivation or validation of a score or algorithm used to stratify the risk of hospitalization or mortality among patients with influenza-like illness in the ED or outpatient clinic.

Results: Twelve articles reporting on eight scores and six predictive models were identified. For predicting the need for hospitalization, the area under the curve (AUC) of the PMEWS and the CURB-65 ranged respectively from 0.76 to 0.94, and 0.65 to 0.88. The Community Assessment Tool had an AUC of 0.62. For predicting inpatient mortality, AUC was 0.66 for PMEWS and 0.79 for CURB-65, 0.79 for the SIRS criteria and 0.86 for the qSOFA score. Two scores were developed without external validation during the Covid-19 pandemic. The CovHos score and the Canadian Covid discharge score had an AUC ranged from 0.70 to 0.91. The predictive models performed adequately (AUC from 0.76 to 0.92) but will require external validation for clinical use. Tool diversity and study population heterogeneity precluded meta-analysis.

Conclusion: Although the CURB, PMEWS and qSOFA scores appear to predict accurately the risk of complications of influenza-like illness, none were reliable enough to justify their widespread ED use. Refinement of an existing tool or development of a new tool to optimize the management of these patients is needed.

Keywords: Hospitalization; Influenza-like illness; Mortality; Outpatient; Risk stratification tool.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Simon Berthelot reports article publishing charges was provided by Quebec Ministry of the Economy and Innovation. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram.
Fig. 2
Fig. 2
Forest plot showing sensitivity and specificity of the scores with external validation selected to predict hospitalization and mortality among patients with influenza-like illness.
See this image and copyright information in PMC

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