title: Comparison of CATs, CURB-65 and PMEWS as triage tools in pandemic influenza admissions to UK hospitals: case control analysis using retrospective data.
abstract: Triage tools have an important role in pandemics to identify those most likely to benefit from higher levels of care. We compared Community Assessment Tools (CATs), the CURB-65 score, and the Pandemic Medical Early Warning Score (PMEWS); to predict higher levels of care (high dependency--Level 2 or intensive care--Level 3) and/or death in patients at or shortly after admission to hospital with A/H1N1 2009 pandemic influenza. This was a case-control analysis using retrospectively collected data from the FLU-CIN cohort (1040 adults, 480 children) with PCR-confirmed A/H1N1 2009 influenza. Area under receiver operator curves (AUROC), sensitivity, specificity, positive predictive values and negative predictive values were calculated. CATs best predicted Level 2/3 admissions in both adults [AUROC (95% CI): CATs 0.77 (0.73, 0.80); CURB-65 0.68 (0.64, 0.72); PMEWS 0.68 (0.64, 0.73), p<0.001] and children [AUROC: CATs 0.74 (0.68, 0.80); CURB-65 0.52 (0.46, 0.59); PMEWS 0.69 (0.62, 0.75), p<0.001]. CURB-65 and CATs were similar in predicting death in adults with both performing better than PMEWS; and CATs best predicted death in children. CATs were the best predictor of Level 2/3 care and/or death for both adults and children. CATs are potentially useful triage tools for predicting need for higher levels of care and/or mortality in patients of all ages.
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Puja R
authors.initials: PR
authors.lastname: Myles
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Nguyen-Van-Tam
authors.forename: Wei Shen
authors.initials: WS
authors.lastname: Lim
authors.forename: Karl G
authors.initials: KG
authors.lastname: Nicholson
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Brett
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Enstone
authors.forename: James
authors.initials: J
authors.lastname: McMenamin
authors.forename: Peter J M
authors.initials: PJ
authors.lastname: Openshaw
authors.forename: Robert C
authors.initials: RC
authors.lastname: Read
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Taylor
authors.forename: Barbara
authors.initials: B
authors.lastname: Bannister
authors.forename: Malcolm G
authors.initials: MG
authors.lastname: Semple
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D015331:Cohort Studies; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D058873:Pandemics / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D014218:Triage / Q000379:methods*; D006113:United Kingdom; D055815:Young Adult