Hospital triage system for adult patients using an influenza-like illness scoring system during the 2009 pandemic--Mexico.

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.

• Authors: Eduardo Rodriguez-Noriega, Esteban Gonzalez-Diaz, Rayo Morfin-Otero, Gerardo F Gomez-Abundis, Jaime Briseño-Ramirez, Hector Raul Perez-Gomez, Hugo Lopez-Gatell, Celia M Alpuche-Aranda, Ernesto Ramírez, Irma López, Miguel Iguala, Ietza Bojórquez Chapela, Ethel Palacios Zavala, Mauricio Hernández, Tammy L Stuart, Margarita Elsa Villarino, Marc-Alain Widdowson, Steve Waterman, Timothy Uyeki, Eduardo Azziz-Baumgartner, Hospital Civil de Guadalajara, Fray Antonio Alcalde Emerging Respiratory Infections Response Team
• Journal: PloS one (PLoS One) Vol. 5 Issue 5 Pg. e10658 (May 14 2010) ISSN: 1932-6203 [Electronic] United States
• PMID: 20498718 (Publication Type: Journal Article)

Topics

• Acute Disease
• Adult
• Age Distribution
• Disease Outbreaks
• Emergency Service, Hospital (statistics & numerical data)
• Female
• Hospitalization (statistics & numerical data)
• Humans
• Influenza A Virus, H1N1 Subtype (physiology)
• Influenza, Human (diagnostic imaging, epidemiology)
• Length of Stay
• Male
• Mexico (epidemiology)
• Radiography
• Risk Factors
• Triage (statistics & numerical data)
• Young Adult