Evidence map›Paper›PMID 40789620›Full record

ArticleJournal of the American Board of Family Medicine : JABFM2025

Development and External Validation of the FluScoreVax Risk Score for Influenza That Incorporates Vaccine Status.

Mark H Ebell, Yewen Chen, Fangzhi Luo, Ye Shen, Samuel Coenen, Paul Little, Bruce Barrett, Daniel Merenstein, Margareta Ieven

Abstract readValidation Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Board of Family Medicine : JABFM, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. The 4Cs of Primary Care, Leveraging Artificial Intelligence, and Improving Clinical Practice.Journal of the American Board of Family Medicine : JABFM · 2025
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Mark H EbellFrom the Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA (MHE); Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA (YC, FL, YS); Centre for General Practice, Department of Family Medicine & Population Health, University of Antwerp, Antwerp, Belgium, b. Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium (SC); Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium (SC, MI); Primary Care and Population Sciences, University of Southampton, Southampton, UK (PL); Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI USA (BB), Department of Family Medicine, Georgetown University, Washington, D.C., USA (DM). ebell.mark@gmail.com.
Yewen ChenFrom the Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA (MHE); Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA (YC, FL, YS); Centre for General Practice, Department of Family Medicine & Population Health, University of Antwerp, Antwerp, Belgium, b. Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium (SC); Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium (SC, MI); Primary Care and Population Sciences, University of Southampton, Southampton, UK (PL); Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI USA (BB), Department of Family Medicine, Georgetown University, Washington, D.C., USA (DM).
Fangzhi LuoFrom the Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA (MHE); Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA (YC, FL, YS); Centre for General Practice, Department of Family Medicine & Population Health, University of Antwerp, Antwerp, Belgium, b. Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium (SC); Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium (SC, MI); Primary Care and Population Sciences, University of Southampton, Southampton, UK (PL); Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI USA (BB), Department of Family Medicine, Georgetown University, Washington, D.C., USA (DM).
Ye ShenFrom the Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA (MHE); Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA (YC, FL, YS); Centre for General Practice, Department of Family Medicine & Population Health, University of Antwerp, Antwerp, Belgium, b. Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium (SC); Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium (SC, MI); Primary Care and Population Sciences, University of Southampton, Southampton, UK (PL); Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI USA (BB), Department of Family Medicine, Georgetown University, Washington, D.C., USA (DM).
Samuel CoenenFrom the Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA (MHE); Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA (YC, FL, YS); Centre for General Practice, Department of Family Medicine & Population Health, University of Antwerp, Antwerp, Belgium, b. Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium (SC); Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium (SC, MI); Primary Care and Population Sciences, University of Southampton, Southampton, UK (PL); Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI USA (BB), Department of Family Medicine, Georgetown University, Washington, D.C., USA (DM).
Paul LittleFrom the Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA (MHE); Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA (YC, FL, YS); Centre for General Practice, Department of Family Medicine & Population Health, University of Antwerp, Antwerp, Belgium, b. Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium (SC); Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium (SC, MI); Primary Care and Population Sciences, University of Southampton, Southampton, UK (PL); Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI USA (BB), Department of Family Medicine, Georgetown University, Washington, D.C., USA (DM).
Bruce BarrettFrom the Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA (MHE); Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA (YC, FL, YS); Centre for General Practice, Department of Family Medicine & Population Health, University of Antwerp, Antwerp, Belgium, b. Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium (SC); Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium (SC, MI); Primary Care and Population Sciences, University of Southampton, Southampton, UK (PL); Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI USA (BB), Department of Family Medicine, Georgetown University, Washington, D.C., USA (DM).
Daniel MerensteinFrom the Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA (MHE); Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA (YC, FL, YS); Centre for General Practice, Department of Family Medicine & Population Health, University of Antwerp, Antwerp, Belgium, b. Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium (SC); Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium (SC, MI); Primary Care and Population Sciences, University of Southampton, Southampton, UK (PL); Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI USA (BB), Department of Family Medicine, Georgetown University, Washington, D.C., USA (DM).
Margareta IevenFrom the Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA (MHE); Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA (YC, FL, YS); Centre for General Practice, Department of Family Medicine & Population Health, University of Antwerp, Antwerp, Belgium, b. Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium (SC); Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium (SC, MI); Primary Care and Population Sciences, University of Southampton, Southampton, UK (PL); Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI USA (BB), Department of Family Medicine, Georgetown University, Washington, D.C., USA (DM).

Funding

AHRQ HHS R01 HS025584
6 · The paper itself

Abstract

introductionTo develop and externally validate a simple risk score for influenza diagnosis based using vaccination history and patient-reported symptoms.

methodsAdult outpatients in 12 European countries during flu season with a chief complaint of acute cough between 2007 and 2010 were used to derive and internally validate the risk score (Genomics to combat Resistance against Antibiotics in Community acquired LRTI in Europe (GRACE) data), and contemporary US data were used for external validation (EAST-PC data). Patient-reported symptoms were recorded and polymerase chain reaction (PCR) was used to diagnose influenza. The score was derived using logistic regression and assigning points based on the

resultsWe developed a risk score with 6 items (subjective fever, interfered with usual activity, headache, wheeze, phlegm, and recent flu vaccine) and a range from -5 to 6 points. The AUC was 0.75 for both derivation and internal validation subgroups. The prevalence of influenza was 15.1% in the GRACE data and 14.4% in the EAST-PC data. The percentage with influenza in the low, moderate, and high-risk groups was 6.8%, 21.8%, 35.3 in the external validation population (EAST-PC data). The low-risk group included 61% of participants in the external validation. Calibration was excellent.

conclusionsWe developed and externally validated the FluScoreVax risk score, available as an app. It classifies 61% of patients as low risk, of whom only 7% had influenza.

Indexed as

Influenza, HumanInfluenza VaccinesVaccinationAdolescentAdultAgedEuropeFemaleHumansMaleMiddle AgedPrevalenceRisk AssessmentRisk FactorsROC CurveUnited StatesInfluenza VaccinesClinical Prediction RuleEvidence-Based MedicineInfectious DiseasesInfluenzaInfluenza VaccinesLogistic RegressionRespiratory DiseasesRisk ScoreTelehealthVaccination

Identifiers

PMID40789620
PMCPMC12616807

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.