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. 2010 May 14;5(5):e10658.
doi: 10.1371/journal.pone.0010658.

Hospital triage system for adult patients using an influenza-like illness scoring system during the 2009 pandemic--Mexico

Eduardo Rodriguez-Noriega  1 , Esteban Gonzalez-Diaz, Rayo Morfin-Otero, Gerardo F Gomez-Abundis, Jaime Briseño-Ramirez, Hector Raul Perez-Gomez, Hugo Lopez-Gatell, Celia M Alpuche-Aranda, Ernesto Ramírez, Irma López, Miguel Iguala, Ietza Bojórquez Chapela, Ethel Palacios Zavala, Mauricio Hernández, Tammy L Stuart, Margarita Elsa Villarino, Marc-Alain Widdowson, Steve Waterman, Timothy Uyeki, Eduardo Azziz-Baumgartner; Hospital Civil de Guadalajara, Fray Antonio Alcalde Emerging Respiratory Infections Response Team
Collaborators, Affiliations

Hospital triage system for adult patients using an influenza-like illness scoring system during the 2009 pandemic--Mexico

Eduardo Rodriguez-Noriega et al. PLoS One. .

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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Influenza Scoring System at the Hospital Civil de Guadalajara during the (H1N1) pandemic 2009—Mexico‡.
Figure 2
Figure 2. Histogram of patients seeking care for acute respiratory infections at Hospital Civil de Guadalajara during the (H1N1) pandemic 2009—Mexico.
Figure 3
Figure 3. Patients seeking care with acute respiratory infections at the Hospital Civil de Guadalajara during the (H1N1) pandemic 2009—Mexico.
Figure 4
Figure 4. Age distribution of patients triaged for acute respiratory infections at the Hospital Civil de Guadalajara during the (H1N1) pandemic 2009—Mexico.
Figure 5
Figure 5. Typical radiological findings of Pandemic (H1N1) 2009 patient at the Hospital Civil de Guadalajara—Mexico.
See this image and copyright information in PMC

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