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

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. A medical history, laboratory and radiology results were collected on em...

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Published in:PloS one 2010-05, Vol.5 (5), p.e10658-e10658
Main Authors: Rodriguez-Noriega, Eduardo, Gonzalez-Diaz, Esteban, Morfin-Otero, Rayo, Gomez-Abundis, Gerardo F, Briseño-Ramirez, Jaime, Perez-Gomez, Hector Raul, Lopez-Gatell, Hugo, Alpuche-Aranda, Celia M, Ramírez, Ernesto, López, Irma, Iguala, Miguel, Bojórquez Chapela, Ietza, Palacios Zavala, Ethel, Hernández, Mauricio, Stuart, Tammy L, Villarino, Margarita Elsa, Widdowson, Marc-Alain, Waterman, Steve, Uyeki, Timothy, Azziz-Baumgartner, Eduardo
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Language:English
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Summary: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. 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. 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
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0010658