SynthesisBMJ open2025
Accuracy of individual signs and symptoms and case definitions for the diagnosis of influenza in different age groups: a systematic review with meta-analysis.
Synthesis in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
7 citing papers in PubMed.
- Risk Factors for Mortality Associated With Influenza Infection in Patients With Hematologic Malignancies: A Cross-Sectional Descriptive Observational Study.Health science reports · 2026Article
- Antiviral Dispensing for Influenza Outpatients Younger Than 65 Years With Comorbidities: A Retrospective Cohort Study.Open forum infectious diseases · 2026Article
- Beyond influenza-like-illness: data-driven syndromic surveillance for fine-scale monitoring of seasonal respiratory viruses.medRxiv : the preprint server for health sciences · 2026Article
- Temporal trends and burden of influenza B virus lineages in Dibrugarh, Assam (2014-2025): predominance of Victoria with early circulation of Yamagata.Archives of virology · 2026Article
- Suppression and resurgence: the evolving epidemiology of seasonal influenza from 2015 to 2024 in a core urban district of Beijing, China.Frontiers in public health · 2026Article
- Factors Associated with Seasonal Influenza Vaccination Among Working-Age Adults in Poland: A Nationwide Cross-Sectional Survey.Vaccines · 2025Article
- Maternal influenza vaccination during pregnancy and the risk of adverse pregnancy and birth outcomes.Frontiers in pharmacology · 2025Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe objective of this study is to perform a comprehensive systematic review and meta-analysis of the accuracy of signs, symptoms and case definitions for the diagnosis of influenza.
designSystematic review and meta-analysis of diagnostic accuracy.
settingInpatient or outpatient setting.
participantsThree databases (PubMed, CINAHL and EMBASE) were searched through February 2024 for studies of clinical diagnosis of influenza using prospective data collection and a high-quality reference standard. Data were abstracted by researchers working in parallel and resolving discrepancies by discussion. PRIMARY AND SECONDARY OUTCOME MEASURES: Quality was assessed using QUADAS-2. Summary estimates (or ranges) of sensitivity and specificity, likelihood ratio (LR), the Youden Index and the area under the receiver operating characteristic curve were calculated.
resultsThe final meta-analysis included 67 studies, each with between 119 and 155 866 participants. Most were judged to be low risk of bias. The signs and symptoms with the highest overall accuracy for all studies based on the Youden Index were any fever (0.32), overall clinical impression (0.28), coryza (0.25), cough and fever (0.25), and measured fever (0.25). Accuracy varied widely by age group. Only the overall clinical impression had a positive LR greater than 2.0. Cough was the most sensitive finding (0.92) with a negative LR of 0.28 in adults. The absence of any fever also had a low negative LR (0.30). The Centers for Disease Control and Prevention (CDC) definition of influenza-like illness (ILI) had good specificity but poor sensitivity in adults, while in infants, it had good sensitivity but widely varying specificity. The European CDC and WHO case definitions for ILI had modest sensitivity and specificity.
conclusionsIndividual signs and symptoms, their combinations, and ILI case definitions have very limited accuracy for identifying persons with influenza. More accurate surveillance and diagnosis will require the development and validation of accurate risk scores or greater use of point-of-care testing.
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