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Free Content Triaging pandemic flu: pneumonia severity scores are not the answer

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SETTING: The 2009 H1N1 influenza pandemic caused significant strain on health systems worldwide. A tool to triage patients at low risk of requiring intensive care services would assist practitioners in safely reducing hospital admission rates during pandemic influenza outbreaks. Community-acquired pneumonia severity scores have not been validated for use in pandemic influenza.

OBJECTIVE: To assess the accuracy of the pneumonia severity index (PSI), CURB-65 and SMRT-CO severity scores in predicting patients at low risk of requiring intensive care services.

DESIGN: Between May and July 2009, 105 patients admitted with laboratory-confirmed pandemic (H1N1) 2009 influenza to Melbourne public hospitals were assessed on admission to determine their pneumonia severity scores and subsequent need for intensive care unit (ICU) support and length of stay.

RESULTS: SMRT-CO was the most accurate score at predicting ICU admission, with an area under the curve of the receiver operating characteristic of 0.826. No score provided good discrimination of low-risk patients, with respectively 19%, 21% and 12% requiring ICU admission as predicted by PSI, CURB-65 and SMRT-CO.

CONCLUSION: Current pneumonia severity scores have insufficient predictive ability to safely identify low-risk patients with pandemic (H1N1) 2009 influenza.

Keywords: influenza; pandemic influenza; pneumonia severity score; severity

Document Type: Research Article


Affiliations: 1: Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia 2: Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, Royal Melbourne and Western Hospitals, University of Melbourne, Parkville, Victoria, Australia

Publication date: 2012-05-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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