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Evaluation of triage methods used to select patients with suspected pandemic influenza for hospital admission
  1. Kirsty Challen1,2,
  2. Steve W Goodacre1,
  3. Richard Wilson1,
  4. Andrew Bentley3,
  5. Mike Campbell4,
  6. Christopher Fitzsimmons5,
  7. Darren Walter6
  1. 1School of Health and Related Research, University of Sheffield, Sheffield, UK
  2. 2Emergency Medicine, North West Deanery, UK
  3. 3Department of Respiratory and Intensive Care Medicine, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
  4. 4Department of Medical Statistics, School of Health and Related Research, University of Sheffield, Sheffield, UK
  5. 5Department of Paediatric Emergency Medicine, Sheffield Children's Hospital, Sheffield, UK
  6. 6Department of Emergency Medicine, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
  1. Correspondence to Kirsty Challen, School of Health and Related Research, University of Sheffield, Regent Court, Sheffield S1 4DA, UK; kirstychallen{at}hotmail.com

Abstract

Objectives Prepandemic projections anticipated huge excess attendances and mortality in an influenza pandemic. A number of tools had been suggested for triaging patients with influenza for inpatient and critical care admission, but none had been validated in these patients. The authors aimed to evaluate three potential triage tools—CURB-65, PMEWS and the Department of Health community assessment tool (CAT)—in patients in the first waves of the 2009 H1N1 pandemic.

Setting Prospective cohort study in three urban emergency departments (one adult, one paediatric, one mixed) in two cities.

Participants All patients presenting to the three emergency departments fulfilling the national definition of suspected pandemic influenza.

Outcome measures 30-day follow-up identified patients who had died or had required advanced respiratory, cardiovascular or renal support.

Results The pandemic was much less severe than expected. A total of 481 patients (347 children) were recruited, of which only five adults fulfilled the outcome criteria for severe illness. The c-statistics for CURB-65, PMEWS and CAT in adults in terms of discriminating between those admitted and discharged were 0.65 (95% CI 0.54 to 0.76), 0.76 (95% CI 0.66 to 0.86) and 0.62 (95% CI 0.51 to 0.72), respectively. In detecting adverse outcome, sensitivities were 20% (95% CI 4% to 62%), 80% (95% CI 38% to 96%) and 60% (95% CI 23% to 88%), and specificities were 94% (95% CI 88% to 97%), 40% (95% CI 32% to 49%) and 81% (95% CI 73% to 87%) for CURB-65, PMEWS and CAT, respectively.

Conclusions Although limited by a paucity of cases, this research shows that current triage methods for suspected pandemic influenza did not reliably discriminate between patients with good and poor outcomes.

  • Cardiac care
  • care systems
  • infectious diseases
  • major incidents
  • respiratory
  • pneumonia/infections

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Footnotes

  • Department of Health Disclaimer: the views and opinions expressed herein are those of the authors and do not necessarily reflect those of the Department of Health.

  • Funding This project was funded by the NIHR Health Technology Assessment programme (project number 09/84/66) and was published in full in Health Technology Assessment Vol 14, No 46, pp 173–236. See the HTA programme website for further project information.

  • Competing interests KC, AB and DW developed the PMEWS score, evaluated in this study. SG, MC, RW and CF have no conflicts of interest.

  • Ethics approval This study was conducted with the approval of the North West MREC and NIGB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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