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. 2010 Feb 18;24(1):203–228. doi: 10.1016/j.idc.2009.10.001

Table 4.

Swine influenza (H1N1) pneumonia: Winthrop-University Hospital Infectious Disease Division's clinical weighted diagnostic point score system for adults and negative rapid influenza diagnostic tests (RIDTs)

Adults with an ILI with dry cough, fever >39°C/102°F and a CXR with no focal/segmental lobar infiltrates and negative RIDTsa:
Key clinical finding:
  • •

    Severe myalgias

 +5
  • •

    Relative lymphopeniab, c

+5
  • •

    Elevated CPK (otherwise unexplained)c

+3
  • •

    Elevated serum transaminases (AST/ALT)c

+2
  • •

    Thrombocytopeniac

+5
Argues against the diagnosis of swine influenza (H1N1) pneumonia:
  • •

    Relative bradycardia

 −5
  • •

    Leukopenia without relative lymphopenia or thrombocytopeniac

−2
  • •

    Atypical lymphocytes

 −1
  • •

    Highly elevated serum ferritin levels (>2 × n)c

−5
  • •

    Hypophosphatemiac

−3
Swine influenza Diagnostic Point Score totals: Maximum score: 20
 Probable swine influenza (H1N1) pneumonia >15
 Possible swine influenza (H1N1) pneumonia 10–15
 Unlikely swine influenza (H1N1) pneumonia <10

Data from Cunha BA, Syed U, Stroll S, et al. 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.

a

Diagnostic tests negative for all other viral CAP pathogens (CMV, SARS, HPS, RSV metapneumoviruses, parainfluenza viruses, adnoviruses).

b

Other causes of relative lymphopenia: Infectious causes: CMV, HHV-6, HHV-8, HIV, military TB, Legionella, typhoid fever, Q fever, brucellosis, SARS, malaria, babesiosis, influenza, avian influenza, RMSF, histoplasmosis, dengue fever, Chickungunya fever, ehrlichiosis, parvovirus B19, HPS, WNE, viral hepatitis (early); Noninfectious causes: cytotoxic drugs, steroids, sarcoidosis, SLE, lymphoma, RA, radiation therapy, Wiskott-Aldrich syndrome, Whipple disease, severe combine immunodeficiency disease (SCID), common variable immune deficiency (CVID), Di George's syndrome, Nezelof's syndrome, intestinal lymphangiectasia, constrictive pericarditis, tricuspid regurgitation, Kawasaki's disease, idiopathic CD4 cytopenia, Wegener's granulomatosis, acute/chronic renal failure, hemodialysis; myasthenia gravis, celiac disease, alcoholic cirrhosis, coronary bypass, CHF, acute pancreatitis, carcinomas (terminal).

c

Otherwise unexplained.