title: Feasibility of web-based self-triage by parents of children with influenza-like illness: a cautionary tale.
abstract: OBJECTIVE
  Self-triage using web-based decision support could be a useful way to encourage appropriate care-seeking behavior and reduce health system surge in epidemics. However, the feasibility and safety of this strategy have not previously been evaluated.
  
  
  OBJECTIVE
  To assess the usability and safety of Strategy for Off-site Rapid Triage (SORT) for Kids, a web-based decision support tool designed to translate clinical guidance developed by the Centers for Disease Control and Prevention to help parents and adult caregivers determine if a child with influenza-like illness requires immediate care in an emergency department (ED).
  
  
  METHODS
  Prospective pilot validation study conducted between February 8 and April 30, 2012. Staff who abstracted medical records and made follow-up calls were blinded to the SORT algorithm's assessment of the child's level of risk.
  
  
  METHODS
  Two pediatric emergency departments in the National Capital Region.
  
  
  METHODS
  Convenience sample of 294 parents and adult caregivers who were at least 18 years of age; able to read and speak English; and the parent or legal guardian of a child 18 years or younger presenting to 1 of 2 EDs with signs and symptoms meeting Centers for Disease Control and Prevention criteria for influenza-like illness.
  
  
  METHODS
  Completion of the SORT for Kids survey.
  
  
  METHODS
  Caregiver ratings of the website's usability and the sensitivity of the underlying algorithm for identifying children who required immediate ED management of influenza-like illness, defined as receipt of 1 or more of 5 essential clinical services.
  
  
  RESULTS
  Ninety percent of participants reported that the website was "very easy" to understand and use. Ratings did not differ by respondent race, ethnicity, or educational attainment. Of the 15 patients whose initial ED visit met explicit criteria for clinical necessity, the Centers for Disease Control and Prevention algorithm classified 14 as high risk, resulting in an overall sensitivity of 93.3% (exact 95% CI, 68.1%-99.8%). Specificity of the algorithm was poor.
  
  
  CONCLUSIONS
  This pilot study suggests that web-based decision support to help parents and adult caregivers self-triage children with influenza-like illness is feasible. However, prospective refinement of the clinical algorithm is needed to improve its specificity without compromising patient safety.
authors.affiliation: RAND Corporation, Arlington, VA 22202, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Anhang Price
authors.forename: Daniel
authors.initials: D
authors.lastname: Fagbuyi
authors.forename: Racine
authors.initials: R
authors.lastname: Harris
authors.forename: Dan
authors.initials: D
authors.lastname: Hanfling
authors.forename: Frederick
authors.initials: F
authors.lastname: Place
authors.forename: Todd B
authors.initials: TB
authors.lastname: Taylor
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Kellermann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007251:Influenza, Human / Q000628:therapy*; D020407:Internet; D008297:Male; D008875:Middle Aged; D010290:Parents; D010865:Pilot Projects; D011446:Prospective Studies; D018570:Risk Assessment; D012449:Safety; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D014218:Triage / Q000379:methods*; D055815:Young Adult