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National swine flu adult assessment guidelines: retrospective validation of objective criteria in three proxy datasets
  1. K Challen1,
  2. A Bentley2,
  3. J Bright1,
  4. J Gray3,
  5. D Walter2
  1. 1Central Manchester Foundation Trust, Manchester, UK
  2. 2University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
  3. 3Yorkshire Ambulance Service NHS Trust (South), UK
  1. Correspondence to Kirsty Challen, Emergency Medicine, Central Manchester Foundation Trust, Oxford Road, Manchester M13 9WL, UK; kirstychallen{at}


Objectives To validate the objective criteria in the Department of Health Adult Swine Flu Assessment Tool against proxy datasets for pandemic influenza.

Design Comparative validation study with 3 datasets.

Setting Urban Emergency Department (group 1) and prehospital care (groups 2 and 3).

Participants Adults with community-acquired pneumonia (group 1, n=281), shortness of breath (group 2, n=211) or any respiratory diagnosis (group 3, n=300).

Outcome measures Hospital admission (group 1), hospital admission or intravenous therapy (group 2) and transfer to emergency department (group 3).

Results Sensitivity and specificity of the tool were 0.73 (95% CI 0.67 to 0.8) and 0.83 (0.72 to 0.9) in group 1, 0.64 (0.55 to 0.71) and 0.63 (0.52 to 0.73) in group 2 and 0.84 (0.75 to 0.9) and 0.55 (0.48 to 0.62) in group 3. Analysis of individual components of the tool and a summative score is presented.

Conclusions The objective criteria of the proposed DH assessment tool do not perform particularly well in predicting relevant clinical outcomes in feasible proxy conditions for pandemic influenza.

  • Infectious diseases
  • poisoning
  • mass incidents

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  • Funding There was no external funding for the study. All authors are NHS employees but had full autonomy in study design and reporting.

  • Competing interests None.

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