title: Impact of the H1N1 influenza pandemic in two rural emergency departments.
abstract: BACKGROUND
  The World Health Organization declared an influenza H1N1 global pandemic in June 2009, which resulted in a great deal of research. However, no studies have been published on incidence, characteristics and impact in rural emergency departments (EDs).
  
  
  METHODS
  Data were gathered from two rural EDs located in Southwestern Ontario. A retrospective chart review was performed on all visits to the hospitals' EDs with ICD-10 codes relating to influenza-like illnesses (ILI). The chart review periods were 1 September 2009 to 1 January 2010 for the H1N1 study group and 1 September 2008 to 1 January 2009 for the control group.
  
  
  RESULTS
  There were 546 cases of ILI during the H1N1 pandemic period out of 8339 total ED visits (6.5%). This was a 4.1 fold increase from the previous year when 132 cases of ILI were identified out of 8125 ED visits (1.6%). Half the cases of ILI that presented during the H1N1 pandemic occurred in patients aged 1 to 20 years, a proportion significantly larger during the pandemic compared with the control period. Time-to-physician assessment did increase significantly during the pandemic (41 min vs 52 min) without resulting in an increased mean length of stay in the ED (122 min vs 120 min). Using the Canadian Triage and Acuity Scale, a patient severity rating that dictates time to medical care, no differences in severity of ILI cases were observed. Nor were there no differences observed in discharge rates, admission rates, transfers to other facilities, unscheduled ED visits with 72 hours, or mortality during the two periods.
  
  
  CONCLUSIONS
  There was a significant increase in the incidence of ILI at the two rural EDs during the H1N1 pandemic compared with the previous year without a corresponding increase in severity of illness.
authors.affiliation: Schulich School of Medicine and Dentistry, London, Ontario, Canada. efalconer2012@meds.uwo.ca
authors.forename: Erin
authors.initials: E
authors.lastname: Falconer
authors.forename: Maeghan
authors.initials: M
authors.lastname: Keddy
authors.forename: William K
authors.initials: WK
authors.lastname: Milne
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002391:Catchment Area, Health / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification; D007251:Influenza, Human / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D038801:International Classification of Diseases; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data* / Q000639:trends; D058873:Pandemics / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data* / Q000639:trends; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D013997:Time Factors