Hospital triage system for adult patients using an influenza-like illness scoring system during the 2009 pandemic--Mexico.
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.
Rodriguez-Noriega
Eduardo
E
Hospital Civil de Guadalajara, Fray Antonio Alcalde, Guadalajara, Jalisco, México.
Gonzalez-Diaz
Esteban
E
Morfin-Otero
Rayo
R
Gomez-Abundis
Gerardo F
GF
Briseño-Ramirez
Jaime
J
Perez-Gomez
Hector Raul
HR
Lopez-Gatell
Hugo
H
Alpuche-Aranda
Celia M
CM
Ramírez
Ernesto
E
López
Irma
I
Iguala
Miguel
M
Bojórquez Chapela
Ietza
I
Palacios Zavala
Ethel
E
Hernández
Mauricio
M
Stuart
Tammy L
TL
Villarino
Margarita Elsa
ME
Widdowson
Marc-Alain
MA
Waterman
Steve
S
Uyeki
Timothy
T
Azziz-Baumgartner
Eduardo
E
D000208:Acute Disease; D000328:Adult; D017677:Age Distribution; D004196:Disease Outbreaks; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000502:physiology*; D007251:Influenza, Human / Q000000981:diagnostic imaging / Q000453:epidemiology*; D007902:Length of Stay; D008297:Male; D008800:Mexico / Q000453:epidemiology; D011859:Radiography; D012307:Risk Factors; D014218:Triage / Q000706:statistics & numerical data*; D055815:Young Adult