title: Evaluation of pneumonia severity and acute physiology scores to predict ICU admission and mortality in patients hospitalized for influenza.
abstract: BACKGROUND
  The demand for inpatient medical services increases during influenza season. A scoring system capable of identifying influenza patients at low risk death or ICU admission could help clinicians make hospital admission decisions.
  
  
  METHODS
  Hospitalized patients with laboratory confirmed influenza were identified over 3 influenza seasons at 25 Ontario hospitals. Each patient was assigned a score for 6 pneumonia severity and 2 sepsis scores using the first data available following their registration in the emergency room. In-hospital mortality and ICU admission were the outcomes. Score performance was assessed using the area under the receiver operating characteristic curve (AUC) and the sensitivity and specificity for identifying low risk patients (risk of outcome <5%).
  
  
  RESULTS
  The cohort consisted of 607 adult patients. Mean age was 76 years, 12% of patients died (71/607) and 9% required ICU care (55/607). None of the scores examined demonstrated good discriminatory ability (AUC>or=0.80). The Pneumonia Severity Index (AUC 0.78, 95% CI 0.72-0.83) and the Mortality in Emergency Department Sepsis score (AUC 0.77, 95% 0.71-0.83) demonstrated fair predictive ability (AUC>or=0.70) for in-hospital mortality. The best predictor of ICU admission was SMART-COP (AUC 0.73, 95% CI 0.67-0.79). All other scores were poor predictors (AUC <0.70) of either outcome. If patients classified as low risk for in-hospital mortality using the PSI were discharged, 35% of admissions would have been avoided.
  
  
  CONCLUSIONS
  None of the scores studied were good predictors of in-hospital mortality or ICU admission. The PSI and MEDS score were fair predictors of death and if these results are validated, their use could reduce influenza admission rates significantly.
authors.affiliation: Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Canada. mullerm@smh.toronto.on.ca
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Muller
authors.forename: Allison J
authors.initials: AJ
authors.lastname: McGeer
authors.forename: Kazi
authors.initials: K
authors.lastname: Hassan
authors.forename: John
authors.initials: J
authors.lastname: Marshall
authors.forename: Michael
authors.initials: M
authors.lastname: Christian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009864:Ontario; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D011014:Pneumonia / Q000175:diagnosis*; D011379:Prognosis; D016896:Treatment Outcome