title: 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.affiliation: Hospital Civil de Guadalajara, Fray Antonio Alcalde, Guadalajara, Jalisco, México.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Rodriguez-Noriega
authors.forename: Esteban
authors.initials: E
authors.lastname: Gonzalez-Diaz
authors.forename: Rayo
authors.initials: R
authors.lastname: Morfin-Otero
authors.forename: Gerardo F
authors.initials: GF
authors.lastname: Gomez-Abundis
authors.forename: Jaime
authors.initials: J
authors.lastname: Briseño-Ramirez
authors.forename: Hector Raul
authors.initials: HR
authors.lastname: Perez-Gomez
authors.forename: Hugo
authors.initials: H
authors.lastname: Lopez-Gatell
authors.forename: Celia M
authors.initials: CM
authors.lastname: Alpuche-Aranda
authors.forename: Ernesto
authors.initials: E
authors.lastname: Ramírez
authors.forename: Irma
authors.initials: I
authors.lastname: López
authors.forename: Miguel
authors.initials: M
authors.lastname: Iguala
authors.forename: Ietza
authors.initials: I
authors.lastname: Bojórquez Chapela
authors.forename: Ethel
authors.initials: E
authors.lastname: Palacios Zavala
authors.forename: Mauricio
authors.initials: M
authors.lastname: Hernández
authors.forename: Tammy L
authors.initials: TL
authors.lastname: Stuart
authors.forename: Margarita Elsa
authors.initials: ME
authors.lastname: Villarino
authors.forename: Marc-Alain
authors.initials: MA
authors.lastname: Widdowson
authors.forename: Steve
authors.initials: S
authors.lastname: Waterman
authors.forename: Timothy
authors.initials: T
authors.lastname: Uyeki
authors.forename: Eduardo
authors.initials: E
authors.lastname: Azziz-Baumgartner
mesh_terms: 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