Rapid Responses to:

LETTERS:
Gavin D Barlow
Prognostic assessment will be important in flu pandemic
BMJ 2006; 332: 490-c-491-c [Full text]
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Rapid Responses published:

[Read Rapid Response] Physiological-social scoring in pandemic flu
Kirsty Challen, John Bright, Andrew Bentley, and Darren Walter   (3 March 2006)

Physiological-social scoring in pandemic flu 3 March 2006
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Kirsty Challen,
Research Fellow in Emergency Medicine
South Manchester University Hospitals Trust,
John Bright, Andrew Bentley, and Darren Walter

Send response to journal:
Re: Physiological-social scoring in pandemic flu

EDITOR While we agree with Bonten and Prins1 that anticipatory planning is required with respect to antibiotic usage in a potential influenza pandemic, there are several issues raised by Dr Barlow’s response2.

Although CURB-65 and CRB-65 have been validated in terms of 30-day mortality3, their limitations with respect to prediction of mortality have recently been highlighted. Their value as a track and triage tool has not been established. This is of prime important as the numbers of presentations expected during a flu pandemic require that an instrument be developed which recognises the physiological derangement and social and comorbid factors which normally influence hospital admission criteria. Ideally this tool would be applicable across the health economy and amenable to use in primary and secondary care by medical, nursing and allied health professionals. Given the magnitude of a pandemic (we calculate that attendances at our emergency department may be in excess of 600% of normal4), it is imperative that any clinical guidance recognises that degradation with scale will occur as the pandemic progresses. We therefore suggest that any triage tool should be scalable in terms of admission threshold.

Using the principle that physiological parameters deteriorate for several hours to days before catastrophic decompensation, we suggest that a modification of the previously published medical early warning score5 will provide a useful triage tool to identify those in need of admission and reassure those fit to self-care at home. The modification addresses comorbid and social factors. We refer readers to our recent correspondence in the European Respiratory Journal for further details of the validation of our tool6.

Kirsty Challen kirsty.challen@smtr.nhs.uk
John Bright
Andrew Bentley
Darren Walter

1. Bonten MJ, Prins JM. Antibiotics in pandemic flu. BMJ 2006;332:248 -9.

2. Barlow GD. Prognostic assessment will be important in flu pandemic. BMJ 2006;332:490-1.

3. Lim W, van der Eerden M, Laing R, Boersma W, Karalus N, Town G, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003;58:377-82.

4. UK Health Departments. UK Influenza Pandemic Contingency Plan. London: Department of Health, 2005.

5. Subbe C, Kruger M, Rutherford P, Gemmell L. Validation of a modified early warning score in medical admissions. Quarterly Journal of Medicine 2001;94:521-6.

6. Challen K, Bright J, Bentley A, Walter D. A physiological-social score for triaging of pandemic influenza patients. European Respiratory Journal 2006;27:in press.

Competing interests: None declared