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PLoS One. 2010 May 14;5(5):e10658.
Hospital Triage System for Adult Patients Using an Influenza-Like Illness Scoring System during the 2009 Pandemic-Mexico.
Rodriguez-Noriega E, Gonzalez-Diaz E, Morfin-Otero R, Gomez-Abundis GF, Briseño-Ramirez J, Perez-Gomez HR, Lopez-Gatell H, Alpuche-Aranda CM, Ramírez E, López I, Iguala M, Chapela IB, Zavala EP, Hernández M, Stuart TL, Villarino ME, Widdowson MA, Waterman S, Uyeki T, Azziz-Baumgartner E; for the Hospital Civil de Guadalajara; Fray Antonio Alcalde Emerging Respiratory Infections Response Team.
Hospital Civil de Guadalajara, Fray Antonio Alcalde, Guadalajara, Jalisco, México.
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 Chi(2), 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.
PMID: 20498718 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/20498718
Hospital Triage System for Adult Patients Using an Influenza-Like Illness Scoring System during the 2009 Pandemic-Mexico.
Rodriguez-Noriega E, Gonzalez-Diaz E, Morfin-Otero R, Gomez-Abundis GF, Briseño-Ramirez J, Perez-Gomez HR, Lopez-Gatell H, Alpuche-Aranda CM, Ramírez E, López I, Iguala M, Chapela IB, Zavala EP, Hernández M, Stuart TL, Villarino ME, Widdowson MA, Waterman S, Uyeki T, Azziz-Baumgartner E; for the Hospital Civil de Guadalajara; Fray Antonio Alcalde Emerging Respiratory Infections Response Team.
Hospital Civil de Guadalajara, Fray Antonio Alcalde, Guadalajara, Jalisco, México.
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 Chi(2), 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.
PMID: 20498718 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/20498718
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