Evaluation of triage methods used to select patients with suspected pandemic influenza for hospital admission

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.