title: Triaging pandemic flu: pneumonia severity scores are not the answer.
abstract: METHODS
  The 2009 H1N1 influenza pandemic caused significant strain on health systems worldwide. A tool to triage patients at low risk of requiring intensive care services would assist practitioners in safely reducing hospital admission rates during pandemic influenza outbreaks. Community-acquired  pneumonia severity scores have not been validated for use in pandemic influenza.
  
  
  OBJECTIVE
  To assess the accuracy of the pneumonia severity index (PSI), CURB-65 and SMRT-CO severity scores in predicting patients at low risk of requiring intensive care services.
  
  
  METHODS
  Between May and  July 2009, 105 patients admitted with laboratory-confirmed pandemic (H1N1) 2009 influenza to Melbourne public hospitals were assessed on admission to determine their pneumonia severity scores and subsequent need for intensive care unit (ICU) support and length of stay.
  
  
  RESULTS
  SMRT-CO  was the most accurate score at predicting ICU admission, with an area under the curve of the receiver operating characteristic of 0.826. No score provided good discrimination of low-risk patients, with respectively 19%, 21% and 12% requiring ICU admission as predicted by PSI, CURB-65 and SMRT-CO.
  
  
  CONCLUSIONS
  Current pneumonia severity scores have insufficient predictive ability to safely identify low-risk patients with pandemic (H1N1) 2009 influenza.
authors.affiliation: Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: R J
authors.initials: RJ
authors.lastname: Commons
authors.forename: J
authors.initials: J
authors.lastname: Denholm
mesh_terms: D017714:Community-Acquired Infections / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D007362:Intensive Care Units; D007902:Length of Stay; D058873:Pandemics; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014218:Triage / Q000379:methods*; D014739:Victoria / Q000453:epidemiology