title: Influenza in the Emergency Department: Vaccination, Diagnosis, and Treatment: Clinical Practice Paper Approved by American Academy of Emergency Medicine Clinical Guidelines Committee.
abstract: BACKGROUND
  Influenza is an acute respiratory virus that results in significant worldwide morbidity and mortality each year. As emergency physicians, we are often the first to encounter patients with seasonal influenza. It is therefore critical that we draw on the most recent and relevant research when we make clinical decisions regarding the diagnosis, treatment, and prophylaxis of this disease.
  
  
  METHODS
  A MEDLINE literature search from August 2009 to August 2015 was performed using the keywords influenza vaccination efficacy AND systematic, influenza AND rapid antigen testing, and Oseltamivir AND systematic, while limiting the search to human studies written in the English language. General review articles and case reports were omitted. Each of the selected articles then underwent a structured review.
  
  
  RESULTS
  We identified 163 articles through our literature search, of which 68 were found to be relevant to our clinical questions. These studies then underwent a rigorous review from which recommendations were given.
  
  
  CONCLUSIONS
  Influenza vaccine efficacy continues to range between 40% and 80%. Vaccination has the potential to decrease disease severity and is recommended for individuals older than 6 months of age. If resources permit, vaccination can be offered to patients presenting to the emergency department. Rapid antigen detection for influenza is a simple bedside test with high specificity, but generally low sensitivity. If a patient presents with a syndrome consistent with influenza and has negative rapid antigen detection, they should either receive a confirmatory reverse transcriptase polymerase chain reaction or be treated as if they have influenza. Treatment with neuraminidase inhibitors can decrease the duration of influenza and is recommended in hospitalized patients, or in those with high risk of complications.
authors.affiliation: Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Abraham
authors.affiliation: Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia.
authors.forename: Jack
authors.initials: J
authors.lastname: Perkins
authors.affiliation: Department of Emergency Medicine, University of California San Diego School of Medicine, San Diego, California.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Vilke
authors.affiliation: Department of Emergency Medicine, University of California San Diego School of Medicine, San Diego, California.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Coyne
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D004636:Emergency Service, Hospital; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D006801:Humans; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D014481:United States
chemical_list: D000998:Antiviral Agents; D004791:Enzyme Inhibitors; D007252:Influenza Vaccines
keywords: H1N1; H3N2; antiviral; efficacy; influenza; oseltamivir; rapid antigen testing; vaccination