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Objectives: To assess the frequency of diagnostic errors in older adults presenting to the emergency department (ED) with symptoms suggestive of Chikungunya virus infection (CVI) and to compare the rates of misdiagnosis of older and younger adults. Design: Cross‐sectional study performed in the University Hospitals of Martinique from retrospective cases. Setting: Emergency department. Participants: Individuals aged 65 and older who attended the ED and underwent reverse transcription polymerase chain reaction (RT‐PCR) testing for CVI between January and December 2014 (n=333, mean age 80±8) were considered eligible and were compared with a randomly selected sample of younger adults (< 65) (n=143, mean age 45±13). Measurements: Misdiagnosis rates. Results: The rate of misdiagnosis of CVI in the ED was 30.6% in individuals aged 65 and older and 6.3% in those younger than 65 (p<.001). The overdiagnosis rate was 9.0% in individuals aged 65 and older and 3.5% in those younger than 65 (p=.04). The underdiagnosis rate was significantly higher (p<.001) in individuals aged 65 and older (21.6%) than in those younger than 65 (2.8%). Conclusion: Misdiagnosis of CVI during an epidemic is statistically more frequent in older than younger adults because clinical presentation is often atypical in older adults. Specific diagnostic tools for older adults and better awareness of ED physicians of different presentations in different age groups could help to reduce the rate of misdiagnosis of CVI in the ED. [ABSTRACT FROM AUTHOR]

Objectives We aimed to determine whether the presentation of Chikungunya virus ( CHIKV) infection differs between older and younger adults with regard to clinical form during the acute phase defined by the World Health Organization: acute clinical, atypical, and severe acute. Design Cross-sectional, retrospective. Setting University Hospital of Martinique. Participants Individuals aged 65 and older (n = 267, mean age 80.4 ± 87.9) who attended the emergency department with a positive biological diagnosis of CHIKV (reverse transcriptase polymerase chain reaction) between January and December 2014 and a randomly selected sample of individuals younger than 65 (n = 109, mean age 46.2 ± 12.7). Results Typical presentation was present in 8.2% of older adults and 59.6% of younger individuals ( P < .001), atypical presentation in 29.6% of older adults and 5.6% of younger individuals ( P < .001), and severe presentation in 19.5% of older adults and 17.4% of younger individuals ( P = .65). One hundred fourteen (42.7%) of the older group and 19 (17.4%) of the younger group could not be classified in any category (absence of fever, absence of joint pain, or both) ( P < .001). Conclusion Only 8.2% of the older adults presenting in the acute phase of CHIKV have typical forms, suggesting that the most-frequent clinical presentation of CHIKV in older adults differs from that in younger individuals. [ABSTRACT FROM AUTHOR]

Background: This study aimed to derive and validate a score for Chikungunya virus (CHIKV) infection screening in old people admitted to acute care units. Methods: This study was performed in the Martinique University Hospitals from retrospective cases. Patients were aged 65+, admitted to acute care units for suspected CHIKV infection in 2014, with biological testing using Reverse Transcription Polymerase Chain Reaction (RT-PCR). RT-PCR was used as the gold standard. A screening score was created using adjusted odds ratios of factors associated with positive RT-PCR derived from a multivariable logistic regression model. A ROC curve was used to determine the best cut-off of the score. Bootstrap analysis was used to evaluate its internal validity. Results: In all, 687 patients were included, 68% with confirmed CHIKV infection, and 32% with laboratory-unconfirmed CHIKV infection. Mean age was 80±8 years, 51% were women. Four variables were found to be independently associated with positive RT-PCR (fever: 3 points; arthralgia of the ankle: 2 points; lymphopenia: 6 points; absence of neutrophil leucocytosis: 10 points). The best cut-off was score ≥12; sensitivity was 87% (83%-90%) and specificity was 70% (63%-76%). Conclusion: This score shows good diagnostic performance and good internal validation and could be helpful to screen aged people for CHIKV infection. [ABSTRACT FROM AUTHOR]