Can the emergency department triage category and clinical presentation predict hospitalization of H1N1 patients?

Abstract

Background

Human H1N1 Influenza A virus was first reported in 2009 when seasonal outbreaks consistently occurred around the world. H1N1 patients present to the emergency departments (ED) with flu-like symptoms extending up to severe respiratory symptoms that require hospital admission. Developing a prediction model for patient outcomes is important to select patients for hospital admission. To date, there is no available data to guide the hospital admission of H1N1 patients based on their initial presentation.

Objective

The aim of this study was to investigate the predictors of hospital admission of H1N1 patients presenting in the ED.

Methods

We conducted a retrospective review of all laboratory-confirmed H1N1 cases presenting to the ED of a tertiary university hospital in the Eastern region of Saudi Arabia within the period from November 2015 to January 2016. We retrieved data of the initial triage category, vital signs, and presenting symptoms. Multivariate logistic regression analysis was performed to evaluate risk factors for hospital admission among H1N1patients presented to the ED.

Results

We identified 333 patients with laboratory-confirmed H1N1. Patients were classified into two groups: admitted group (n=80; 24%) and non-admitted group (n=253; 76%). Sixty patients (75%) were triaged under category IV. Triage category of level III and less were the most predictive for hospital admission. Multivariate regression analysis showed that of all vital signs, tachypnea was a significant risk factor for hospital admission (OR=1.1; 95% CI 1.02 to 1.13, p<0.01). The association between lower triage category and hospital stay was statistically significant (χ²=6.068, p=0.037). Also, patients with dyspnea were 4.5 times more likely to have longer hospital stay (OR=4.5; 95% CI 1.2 to 17.1, p=0.025).

Conclusion

Lower triage category and increased respiratory rate predict the need for hospital admission of H1N1 infected patients; while patients with dyspnea or bronchial asthma are likely to stay longer in the hospital. Further prospective studies are needed to evaluate the accuracy of using the CTAS and other clinical parameters in predicting hospitalization of H1N1 patients during outbreaks.

Keywords:

• clinical outcome
• H1N1
• presentation
• respiratory virus
• triage category

Ethics approval and consent to participate

Patient consent was not required, and all patient data were kept confidential. No patients were involved neither in the design, recruitment and conduction of this study nor in the development of outcome measures. We will publish the results of the study in lay language for patient interest groups. We obtained ethics approval from Standing Committee for Research Ethics on Living Creatures (SCRELC) from the Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia with IRB number: IRB-UGS-2016-01-076.

Abbreviations

BA, Bronchial asthma; CI, Confidence interval; CRP, C-reactive protein; CTAS, Canadian triage and acuity scale; CVD, Cardiovascular disease; DM, Diabetes mellitus; ED, Emergency departments; H1N1, Hemagglutinin type 1 and neuraminidase type 1; ICU, Intensive care unit; OR, Odds ratio; PCR, Polymerase chain reaction; STSS, Simple triage scoring system.

Acknowledgment

We wish to acknowledge the King Fahad Hospital of the University administrators and staff for providing much needed assistance throughout the course of this research. We thank our colleagues from the emergency department who provided insight and expertise that greatly assisted the research and for their comments on an earlier version of the manuscript. Dr Mohammed Alshahrani provided funding for NegidaClin^® Contract Research Organization to perform professional language editing and revision of the manuscript.

Author contributions

All authors contributed toward data analysis, drafting and revising the paper, gave final approval of the version to be published and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.