Journal of Postgraduate Medicine
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Year : 2013  |  Volume : 59  |  Issue : 2  |  Page : 162-163  

Clinical features scoring system for H1N1

Somsri Wiwanitkit1, Viroj Wiwanitkit2,  
1 Wiwanitkit House, Bangkhae, Bangkok, Thailand
2 Hainan Medical University, China, Faculty of Medicine, University of Nis, Serbia, Joseph Ayobabalola University, Nigeria

Correspondence Address:
Somsri Wiwanitkit
Wiwanitkit House, Bangkhae, Bangkok

How to cite this article:
Wiwanitkit S, Wiwanitkit V. Clinical features scoring system for H1N1.J Postgrad Med 2013;59:162-163

How to cite this URL:
Wiwanitkit S, Wiwanitkit V. Clinical features scoring system for H1N1. J Postgrad Med [serial online] 2013 [cited 2022 Jun 25 ];59:162-163
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Dear Editor,

The recent report on "clinical features scoring system for H1N1" is very interesting. [1] Ranjan et al. concluded that the clinical feature scoring system is a cost-effective screening tool. [1] Indeed, the use of scoring system has been previously proposed in many clinical settings since the outbreak of H1N1 influenza around the world. The good pioneer example is the scoring system of Winthrop-University Hospital. [2] Based on the study by Cunha et al., [2] some clinical features were used for constructing a clinical scoring system for presumptive diagnosis of H1N1 influenza and it was proved for usefulness. There is no doubt that on using any scoring system for screening might reduce the cost for performing standard laboratory diagnosis. Comparing to standard reverse transcriptase polymerase chain reaction based tool, using scoring system is significantly cheaper.

On the other hand, the cons for using the scoring system as a screening tool should be mentioned. First, the problem of accuracy and reliability should be kept in mind. According to a recent report from Taiwan, the sensitivity and specificity of using scoring system in diagnosis are lower than 70%, which is considerable not acceptable in laboratory medicine. [3] Another argument in using scoring system is the difficulty of scoring. Sometimes, it might take times and requires guideline to score. [4] Based on the report from Winthrop-University Hospital where the scoring technique is used as the pioneer, it was finally concluded that diagnostic point score system was time-consuming. [5] The scoring system is mentioned not appropriate for the outbreak situation. [5] The new clinical triad, influenza like illness, a fever >102°F with severe myalgias, and a chest X-ray without focal segmental/lobar infiltrates were later developed by Winthrop-University Hospital as a new tool for screening. [6]

In conclusion, although the cost of clinical features scoring system for H1N1 screening is low there are many considerations. To improve the system, the adjustment to reduce the complexity and set a practical guideline for using it is suggested. Possible measures which can improve the scoring system and increase its effectiveness in diagnosing H1N1 are (a) setting a forum for brainstorming of expert to adjust the content of the scoring system, (b) international metanalytic study on characteristics of H1N1 cases to find the useful lists for inclusion into the scoring system and (c) combining the scoring system with point-of-care influenza testing. Nevertheless, both lab diagnosis and scoring system should go hand in hand and physician-in-charge should not totally rely only on the scoring system because subjective variations are possible.


1Ranjan P, Kumari A, Das R, Gupta L, Singh SK, Yadav M. Evaluation of clinical features scoring system as screening tool for influenza A (H1N1) in epidemic situations. J Postgrad Med 2012;58:265-9.
2Cunha BA, Syed U, Stroll S, Mickail N, Laguerre M. Winthrop-University Hospital Infectious Disease Division's swine influenza (H1N1) pneumonia diagnostic weighted point score system for hospitalized adults with influenza-like illnesses (ILIs) and negative rapid influenza diagnostic tests (RIDTs). Heart Lung 2009;38:534-8.
3Lin CY, Chi H, Lin HY, Chang L, Hou JY, Huang CT, et al. A scoring system for predicting results of influenza rapid test in children: A possible model facing overwhelming pandemic infection. J Microbiol Immunol Infect 2012;45:271-5.
4Wiwanitkit V. Scoring system for diagnosis of swine flu. Heart Lung 2010;39:345-6.
5Cunha BA, Syed U, Mickail N, Strollo S. Rapid clinical diagnosis in fatal swine influenza (H1N1) pneumonia in an adult with negative rapid influenza diagnostic tests (RIDTs): Diagnostic swine influenza triad. Heart Lung 2010;39:78-86.
6Cunha BA, Mickail N, Syed U, Strollo S, Laguerre M. Rapid clinical diagnosis of Legionnaires' disease during the "herald wave" of the swine influenza (H1N1) pandemic: The Legionnaires' disease triad. Heart Lung 2010;39:249-59.

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