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Hospital Triage System for Adult Patients Using an Influenza - Like Illness Scoring System during the 2009 Pandemic?Mexico (published: PLoS One May 14, 2010)
CIDRAP News Scan May 17 2010:
Clinical flu symptoms help guide triage A triage system that scored emergency room patients for influenza-like illness (ILI) complemented clinical judgment in deciding antiviral treatment, according to a new study. Patients in a Guadalajara, Mexico, hospital last year received scores for various ILI signs, symptoms, or lab results (eg, "2" for cough, fever, fatigue, difficulty breathing, or underlying condition). An ILI score of 7 or greater indicated a possible need for antiviral drugs, and 16 or higher for hospitalization.
PLoS ONE: Published: May 14, 2010
Rodriguez-Noriega E, Gonzalez-Diaz E, Morfin-Otero R, Gomez-Abundis GF, Brise?o-Ramirez J, et al. (2010)
Hospital Triage System for Adult Patients Using an Influenza-Like Illness Scoring System during the 2009 Pandemic?Mexico.
PLoS ONE 5(5): e10658. doi:10.1371/journal.pone.0010658
Abstract
Background
Pandemic influenza A (H1N1) virus emerged during 2009. To help clinicians triage adults with acute respiratory illness, a scoring system for influenza-like illness (ILI) was implemented at Hospital Civil de Guadalajara, Mexico.
Methods
A medical history, laboratory and radiology results were collected on emergency room (ER) patients with acute respiratory illness to calculate an ILI-score. Patients were evaluated for admission by their ILI-score and clinicians' assessment of risk for developing complications. Nasal and throat swabs were collected from intermediate and high-risk patients for influenza testing by RT-PCR. The disposition and ILI-score of those oseltamivir-treated versus untreated, clinical characteristics of 2009 pandemic influenza A (H1N1) patients versus test-negative patients were compared by Pearson's Χ2, Fisher's Exact, and Wilcoxon rank-sum tests.
Results
Of 1840 ER patients, 230 were initially hospitalized (mean ILI-score = 15), and the rest were discharged, including 286 ambulatory patients given oseltamivir (median ILI-score = 11), and 1324 untreated (median ILI-score = 5). Fourteen (1%) untreated patients returned, and 3 were hospitalized on oseltamivir (median ILI-score = 19). Of 371 patients tested by RT-PCR, 104 (28%) had pandemic influenza and 42 (11%) had seasonal influenza A detected. Twenty (91%) of 22 imaged hospitalized pandemic influenza patients had bilateral infiltrates compared to 23 (38%) of 61 imaged hospital test-negative patients (p<0.001). One patient with confirmed pandemic influenza presented 6 days after symptom onset, required mechanical ventilation, and died.
Conclusions
The triaging system that used an ILI-score complimented clinicians' judgment of who needed oseltamivir and inpatient care and helped hospital staff manage a surge in demand for services.
Clinical flu symptoms help guide triage A triage system that scored emergency room patients for influenza-like illness (ILI) complemented clinical judgment in deciding antiviral treatment, according to a new study. Patients in a Guadalajara, Mexico, hospital last year received scores for various ILI signs, symptoms, or lab results (eg, "2" for cough, fever, fatigue, difficulty breathing, or underlying condition). An ILI score of 7 or greater indicated a possible need for antiviral drugs, and 16 or higher for hospitalization.
PLoS ONE: Published: May 14, 2010
Rodriguez-Noriega E, Gonzalez-Diaz E, Morfin-Otero R, Gomez-Abundis GF, Brise?o-Ramirez J, et al. (2010)
Hospital Triage System for Adult Patients Using an Influenza-Like Illness Scoring System during the 2009 Pandemic?Mexico.
PLoS ONE 5(5): e10658. doi:10.1371/journal.pone.0010658
Abstract
Background
Pandemic influenza A (H1N1) virus emerged during 2009. To help clinicians triage adults with acute respiratory illness, a scoring system for influenza-like illness (ILI) was implemented at Hospital Civil de Guadalajara, Mexico.
Methods
A medical history, laboratory and radiology results were collected on emergency room (ER) patients with acute respiratory illness to calculate an ILI-score. Patients were evaluated for admission by their ILI-score and clinicians' assessment of risk for developing complications. Nasal and throat swabs were collected from intermediate and high-risk patients for influenza testing by RT-PCR. The disposition and ILI-score of those oseltamivir-treated versus untreated, clinical characteristics of 2009 pandemic influenza A (H1N1) patients versus test-negative patients were compared by Pearson's Χ2, Fisher's Exact, and Wilcoxon rank-sum tests.
Results
Of 1840 ER patients, 230 were initially hospitalized (mean ILI-score = 15), and the rest were discharged, including 286 ambulatory patients given oseltamivir (median ILI-score = 11), and 1324 untreated (median ILI-score = 5). Fourteen (1%) untreated patients returned, and 3 were hospitalized on oseltamivir (median ILI-score = 19). Of 371 patients tested by RT-PCR, 104 (28%) had pandemic influenza and 42 (11%) had seasonal influenza A detected. Twenty (91%) of 22 imaged hospitalized pandemic influenza patients had bilateral infiltrates compared to 23 (38%) of 61 imaged hospital test-negative patients (p<0.001). One patient with confirmed pandemic influenza presented 6 days after symptom onset, required mechanical ventilation, and died.
Conclusions
The triaging system that used an ILI-score complimented clinicians' judgment of who needed oseltamivir and inpatient care and helped hospital staff manage a surge in demand for services.