Influenza diagnosis and treatment in veterans with spinal cord injury

Objective: To assess influenza diagnosis and treatment behaviors and prescribing practices for antiviral medications among spinal cord injury (SCI) practitioners. Design: Anonymous cross-sectional survey of practitioners and retrospective review of administrative diagnostic and prescription databases. Setting: Department of Veterans Affairs health care facilities. Participants: One hundred practitioners participated (response rate, 65%). Interventions: Not applicable. Main Outcome Measures: Strategies for diagnosing and treating influenza and type of antivirals prescribed. Results: Ninety-seven percent of practitioners reported using clinical symptoms to diagnose a patient with influenza. The most common treatments included symptom relievers (94%), followed by antivirals (21%). Antivirals reportedly used included amantadine (64%), rimantadine (36%), oseltamivir (32%), and zanamivir (11%). Twenty-one prescriptions for antivirals were identified during the influenza season and all were for amantadine. Conclusions: Despite recommendations by the U.S. Centers for Disease Control and Prevention and high risks of respiratory complications after SCI, antiviral medications and diagnostic tests for influenza are seldom used in the treatment of influenza in this population. Research is needed to identify barriers to diagnosing and administering antivirals in people with SCI.