MSU Department of Family Medicine faculty member Mark Ebell MD, MS is part of a team that summarizes about 25 new studies relevant to primary care practice every month. We included a sample about FluScoreVax in this newsletter, based on a study from Dr. Ebell. It is reprinted with permission of the publisher. To learn more about POEMs visit Essential Evidence Plus Web site (www.essentialevidenceplus.com).
FluScoreVax incorporates vaccination history to accurately predict influenza risk
Clinical Question: Is the FluScoreVax risk scoring tool accurate for assessing the risk of influenza in adult outpatients with a chief complaint of acute cough?
Funding Source: Government Study Design: Decision rule (validation)
Setting: Outpatient (primary care)
Synopsis: Development of the original FluScore risk tool for predicting influenza occurred without access to vaccination data. These investigators used data that was obtained from 12 European countries during flu season to derive and internally validate the updated FluScoreVax, which incorporates vaccine status, on 1526 adults who presented to outpatient clinics with acute cough or who were suspected of having a lower respiratory tract infection. Patient-reported symptoms were recorded, with polymerase chain reaction (PCR) testing serving as the reference standard for diagnosing influenza. The final risk score is shown below and was externally validated in a contemporary US population dataset. The overall prevalence of influenza in both studies was approximately 15%. The FluScoreVax classified 61% of patients in the external validation cohort as low risk (-5 to 0 points) with only 7% testing positive for influenza. FluScoreVax is available as a free app: https://ebell-projects.shinyapps.io/FluScoreVax/
| Predictor | Points | Risk group | Flu/total (GRACE) | Flu/total (EASTPC) | |
| Fever (subjective) | +4 | Low risk (-5 to 0) | 39/580 (6.7%) | 22/325 (6.8%) | |
| Interfered w/usual activity | +1 | Moderate risk (1 to 3) | 56/280 (20%) | 31/142 (22%) | |
| Headache | +1 | High risk (4 to 6) | 55/132 (42%) | 24/68 (35%) | |
| Wheeze | -1 | ||||
| Phlegm production | -2 | ||||
| Flu vaccine this year | -2 | ||||
| Total (range -5 to 6) |
Bottom line: The updated FluScoreVax risk score, now incorporating vaccination status, accurately identifies adults presenting with acute cough during flu season at low risk of influenza. These patients are unlikely to benefit from point-of-care influenza testing or treatment.
Ebell MH, Chen Y, Luo F, et al. Development and external validation of the FluScoreVax risk score for influenza that incorporates vaccine status. J Am Board Fam Med 2025;38:401-410.
