Hospital Triage System for Adult Patients Using an Influenza-Like Illness Scoring System during the 2009 Pandemic—Mexico

Noriega, Eduardo Rodríguez; González-Díaz, Esteban; Morfín‐Otero, Rayo; Gomez-Abundis, Gerardo F.; Briseño-Ramirez, Jaime; Pérez-Gómez, Héctor Raúl; López‐Gatell, Hugo; Alpuche-Aranda, Celia; Ramírez, Ernesto; López, Irma; Iguala, Miguel; Chapela, Ietza Bojórquez; Zavala, Ethel Palacios; Hernández, Mauricio; Stuart, Tammy L.; Villarino, Margarita E.; Widdowson, Marc‐Alain; Waterman, Steve; Uyeki, Timothy M.; Azziz‐Baumgartner, Eduardo; Team, Fray Antonio Alcalde Emerging Respiratory Infections Response

doi:10.1371/journal.pone.0010658

Cited by 21 publications

(19 citation statements)

References 19 publications

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“…It has been shown that the ER patient flow during influenza outbreaks significantly increases, and challenges the routine of these first-line clinical units [7]. The development of specific triage algorithms might improve their performance, as well as the infection control practices [8]. Not surprisingly, the most difficult issues to resolve within Spanish hospitals were the vaccination of healthcare professionals (HCPs) and the low awareness of HCPs regarding infection control and the prevention of influenza transmission [9].…”

Section: Discussionmentioning

confidence: 99%

Perspectives from Spanish infectious diseases professionals on 2009 A (H1N1) influenza: the third half

Paño‐Pardo

Martín-Quirós

Romero‐Gómez

et al. 2011

Clinical Microbiology and Infection

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The first influenza pandemic in more than 40 years was declared in 2009. We aimed to evaluate the beliefs of Spanish infectious diseases professionals regarding several aspects of 2009 A (H1N1) influenza once the epidemic waned. An online survey was designed and distributed among members of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). The survey considered hospital organization and preparedness planning and conduct, as well as the opinion of the infectious diseases professionals regarding several key issues. Between 7 March and 22 March 2010, 303 responses, corresponding to 12.8% of the SEIMC membership, were received. Of the respondents, 48.2% were microbiologists and 42.3% were clinicians dealing with infectious diseases. Forty-one per cent of respondents did not believe that 2009 A (H1N1) influenza had a more severe presentation than other seasonal influenzas. Only 5% fully agreed that 2009 A (H1N1) influenza had a more severe presentation. Influenza planning was available in 69.7% of represented institutions before the arrival of 2009 A (H1N1) influenza, and was considered to be useful, to different extents, by most professionals. In most institutions (88.3%), a multidisciplinary team was created to coordinate local pandemic influenza actions. The most successful protocols were those provided by regional healthcare authorities, followed by those from the CDC. The most problematic issues regarding 2009 A (H1N1) influenza were the management of patients in the emergency room and the vaccination and awareness of healthcare professionals (HCPs) regarding infection control. Microbiological diagnosis and the availability of antivirals were the least problematic areas. Although the majority of surveyed infectious diseases professionals did not believe that 2009 A (H1N1) influenza had an especially severe presentation, most of them agreed with the way that this epidemic was managed in their institutions.

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Section: Discussionmentioning

confidence: 99%

Perspectives from Spanish infectious diseases professionals on 2009 A (H1N1) influenza: the third half

Paño‐Pardo

Martín-Quirós

Romero‐Gómez

et al. 2011

Clinical Microbiology and Infection

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“…No children aged <5 years received early treatment, and only 20% received oseltamivir within 48 hours of the physician visit. Although a previous case-series of 251 children infected with influenza A H1N1pdm with 13 fatalities did not find a difference between prompt consultation, ICU admission, survival, and oseltamivir treatment [3], we recommend early treatment based on the findings of larger case-series [31]. The apparent reluctance to provide early antivirals to young children may have been caused by the clinician's lack of familiarity with the use of oseltamivir and their concerns over potential adverse events among very young children.…”

Section: Discussionmentioning

confidence: 75%

An Analysis of 332 Fatalities Infected with Pandemic 2009 Influenza A (H1N1) in Argentina

et al. 2012

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BackgroundThe apparent high number of deaths in Argentina during the 2009 pandemic led to concern that the influenza A H1N1pdm disease was different there. We report the characteristics and risk factors for influenza A H1N1pdm fatalities.MethodsWe identified laboratory-confirmed influenza A H1N1pdm fatalities occurring during June-July 2009. Physicians abstracted data on age, sex, time of onset of illness, medical history, clinical presentation at admission, laboratory, treatment, and outcomes using standardize questionnaires. We explored the characteristics of fatalities according to their age and risk group.ResultsOf 332 influenza A H1N1pdm fatalities, 226 (68%) were among persons aged <50 years. Acute respiratory failure was the leading cause of death. Of all cases, 249 (75%) had at least one comorbidity as defined by Advisory Committee on Immunization Practices. Obesity was reported in 32% with data and chronic pulmonary disease in 28%. Among the 40 deaths in children aged <5 years, chronic pulmonary disease (42%) and neonatal pathologies (35%) were the most common co-morbidities. Twenty (6%) fatalities were among pregnant or postpartum women of which only 47% had diagnosed co-morbidities. Only 13% of patients received antiviral treatment within 48 hours of symptom onset. None of children aged <5 years or the pregnant women received antivirals within 48 h of symptom onset. As the pandemic progressed, the time from symptom-onset to medical care and to antiviral treatment decreased significantly among case-patients who subsequently died (p<0.001).ConclusionPersons with co-morbidities, pregnant and who received antivirals late were over-represented among influenza A H1N1pdm deaths in Argentina, though timeliness of antiviral treatment improved during the pandemic.

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“…We developed a scoring system using eight factors in an attempt to improve on the accuracy of the case definitions. While others have devised a simple score incorporating clinical and laboratory data in determining the likelihood of H1N1/09 pneumonia compared to other causes of community‐acquired pneumonia, or the need for hospitalization, to the best of our knowledge, this is the first scoring system based entirely on variables immediately available to the clinician 21,22 . The scoring system marginally outperformed the case definitions – score group 3, for example, had equivalent or superior predictive values to any of the CDNA definitions – and was of similar discrimination to the logistic regression (AUROC 0·73 versus 0·75).…”

Section: Discussionmentioning

confidence: 99%

Diagnosing swine flu: the inaccuracy of case definitions during the 2009 pandemic, an attempt at refinement, and the implications for future planning

Mahony¹,

Cheng²,

Olsen³

et al. 2012

Influenza and Other Respiratory Viruses

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Background At the onset of the pandemic H1N1/09 influenza A outbreak in Australia, health authorities devised official clinical case definitions to guide testing and access to antiviral therapy. Objectives To assess the diagnostic accuracy of these case definitions and to attempt to improve on them using a scoring system based on clinical findings at presentation. Patients/Methods This study is a retrospective case–control study across three metropolitan Melbourne hospitals and one associated community‐based clinic during the influenza season, 2009. Patients presenting with influenza‐like illness who were tested for H1N1/09 influenza A were administered a standard questionnaire of symptomatology, comorbidities, and risk factors. Patients with a positive test were compared to those with a negative test. Logistic regression was performed to examine for correlation of clinical features with disease. A scoring system was devised and compared with case definitions used during the pandemic. The main outcome measures were the positive and negative predictive values of our scoring system, based on real‐life data, versus the mandated case definitions’. Results Both the devised scoring system and the case definitions gave similar positive predictive values (38–58% using ascending score groups, against 39–44% using the various case definitions). Negative predictive values were also closely matched (ranging from 94% to 73% in the respective score groups against 83–84% for the case definitions). Conclusions Accurate clinical diagnosis of H1N1/09 influenza A was difficult and not improved significantly by a structured scoring system. Investment in more widespread availability of rapid and sensitive diagnostic tests should be considered in future pandemic planning.

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Hospital Triage System for Adult Patients Using an Influenza-Like Illness Scoring System during the 2009 Pandemic—Mexico

Cited by 21 publications

References 19 publications

Perspectives from Spanish infectious diseases professionals on 2009 A (H1N1) influenza: the third half

Perspectives from Spanish infectious diseases professionals on 2009 A (H1N1) influenza: the third half

An Analysis of 332 Fatalities Infected with Pandemic 2009 Influenza A (H1N1) in Argentina

Diagnosing swine flu: the inaccuracy of case definitions during the 2009 pandemic, an attempt at refinement, and the implications for future planning

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