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dc.contributor.authorSmith, BJ
dc.contributor.authorPrice, DJ
dc.contributor.authorJohnson, D
dc.contributor.authorGarbutt, B
dc.contributor.authorThompson, M
dc.contributor.authorIrving, LB
dc.contributor.authorPutland, M
dc.contributor.authorTong, SYC
dc.date.accessioned2020-11-17T03:26:58Z
dc.date.available2020-11-17T03:26:58Z
dc.date.issued2020-07-01
dc.identifierpii: ofaa268
dc.identifier.citationSmith, B. J., Price, D. J., Johnson, D., Garbutt, B., Thompson, M., Irving, L. B., Putland, M. & Tong, S. Y. C. (2020). Influenza With and Without Fever: Clinical Predictors and Impact on Outcomes in Patients Requiring Hospitalization. OPEN FORUM INFECTIOUS DISEASES, 7 (7), https://doi.org/10.1093/ofid/ofaa268.
dc.identifier.issn2328-8957
dc.identifier.urihttp://hdl.handle.net/11343/251503
dc.description.abstractBackground: The Infectious Diseases Society of America influenza guidelines no longer require fever as part of their influenza case definition in patients requiring hospitalization. However, the impact of fever or lack of fever on clinical decision-making and patient outcomes has not been studied. Methods: We conducted a retrospective review of adult patients admitted to our tertiary health service between April 2016 and June 2019 with laboratory-confirmed influenza, with and without fever (≥37.8ºC). Patient demographics, presenting features, and outcomes were analyzed using Pearson's chi-square test, the Wilcoxon rank-sum test, and logistic regression. Results: Of 578 influenza inpatients, 219 (37.9%) had no fever at presentation. Fever was less likely in individuals with a nonrespiratory syndrome (adjusted odds ratio [aOR], 0.44; 95% CI, 0.26-0.77), symptoms for ≥3 days (aOR, 0.53; 95% CI, 0.36-0.78), influenza B infection (aOR, 0.45; 95% CI, 0.29-0.70), chronic lung disease (aOR, 0.55; 95% CI, 0.37-0.81), age ≥65 (aOR, 0.36; 95% CI, 0.23-0.54), and female sex (aOR, 0.69; 95% CI, 0.48-0.99). Patients without fever had lower rates of testing for influenza in the emergency department (64.8% vs 77.2%; P = .002) and longer inpatient stays (median, 2.4 vs 1.9 days; P = .015). These patients were less likely to receive antiviral treatment (55.7% vs 65.6%; P = .024) and more likely die in the hospital (3.2% vs 0.6%; P = .031), and these differences persisted after adjustment for potential confounders. Conclusions: Absence of fever in influenza is associated with delayed diagnosis, longer length of stay, and higher mortality.
dc.languageEnglish
dc.publisherOXFORD UNIV PRESS INC
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0
dc.titleInfluenza With and Without Fever: Clinical Predictors and Impact on Outcomes in Patients Requiring Hospitalization
dc.typeJournal Article
dc.identifier.doi10.1093/ofid/ofaa268
melbourne.affiliation.departmentDoherty Institute
melbourne.source.titleOpen Forum Infectious Diseases
melbourne.source.volume7
melbourne.source.issue7
melbourne.identifier.nhmrc1145033
dc.rights.licenseCC BY-NC-ND
melbourne.elementsid1456340
melbourne.contributor.authorPrice, David
melbourne.contributor.authorTong, Steven
melbourne.contributor.authorIrving, Louis
melbourne.contributor.authorJohnson, Douglas
melbourne.contributor.authorPutland, Mark
melbourne.contributor.authorSmith, Benjamin
dc.identifier.eissn2328-8957
melbourne.identifier.fundernameidNHMRC, 1145033
melbourne.accessrightsOpen Access


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