Liao et al reported a clinical prediction rule for the diagnosis of avian influenza A (H7N9). This is suitable for diagnosis in the Emergency Department or other acute care setting. The authors are from Chinese Center for Disease Control and Prevention in Beijing.
Patient selection: adult with respiratory symptoms during outbreak of avian influenza, designated high risk by the step 1 score
Parameters:
(1) sex
(2) history of poultry exposure
(3) hemoptysis
(4) shortness of breath
(5) fever
(6) chest X-ray
(7) WBC count
(8) hemoglobin
Parameter
Finding
Points
sex
female
0
male
11
history of poultry exposure
absent
0
present
54
hemoptysis
absent
0
present
15
shortness of breath
absent
0
present
30
fever
absent
0
present
37
chest radiography
normal
0
pneumonia, consolidation
23
WBC count
low (< 4,000 per µL)
22
normal
0
high (> 11,000 per µL)
-21
hemoglobin
low (< 12 g/dL)
-12
normal
0
high (>= 16 g/dL)
-1
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: -33
• maximum score: 192
• A score < 68 indicates low risk.
• A patient with a score >= 68 is high risk.
Score
Percent with H7N9
< 68
0.3%
68 to 70
2.5%
71 to 90
4.3%
> 90
44%
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