# 4455
When the ER is getting slammed, as it does during every surge in influenza, Emergency room physicians are faced with having to decide which flu patients are stable enough to go home, and which need to be admitted.
It isn’t an easy task.
And as the hospital fills up, and beds become a scarce commodity, the definition of who really needs to be admitted narrows. Since 99% of H1N1 patients do fine at home, the problem becomes one of triage:
How do you spot the 1% at genuine risk of serious complications?
In April’s journal Radiology, a study out of Israel the suggests that chest X-rays can provide important clues as to which patients will go on to have adverse outcomes.
- Of 97 patients that received chest x-rays upon admission, 40% (n=39) had abnormal findings. Five of those (13%) went on to see adverse outcomes.
- Of the remainder (n=58) with normal x-rays, only two (3%) went on to see adverse outcomes.
While not perfect (nothing ever is in emergency medicine), x-ray findings appear to provide valuable clues in how well patients will fare with the H1N1 virus.
The following excerpts are from the study’s abstract. Follow the link to read it in its entirety.
H1N1 Influenza: Initial Chest Radiographic Findings in Helping Predict Patient Outcome
- Galit Aviram, MD, Amir Bar-Shai, MD, Jacob Sosna, MD, Ori Rogowski, MD, Galia Rosen, MD, Iuliana Weinstein, MD, Arie Steinvil, MD and Ofer Zimmerman, MD
Abstract (Excerpts)
Purpose: To retrospectively evaluate whether findings on initial chest radiographs of influenza A (H1N1) patients can help predict clinical outcome.
Results: Of 179 H1N1 influenza patients, 97 (54%) underwent chest radiography at admission; 39 (40%) of these had abnormal radiologic findings likely related to influenza infection and five (13%) of these 39 had adverse outcomes. Fifty-eight (60%) of 97 patients had normal radiographs; two (3%) of these had adverse outcomes (P = .113).
Characteristic imaging findings included the following: ground-glass (69%), consolidation (59%), frequently patchy (41%), and nodular (28%) opacities. Bilateral opacities were common (62%), with involvement of multiple lung zones (72%) . . .
Conclusion: Extensive involvement of both lungs, evidenced by the presence of multizonal and bilateral peripheral opacities, is associated with adverse prognosis. Initial chest radiography may have significance in helping predict clinical outcome but normal initial radiographs cannot exclude adverse outcome.
