Tool 7 – Clinical Triage Guidelines
During Pandemic Critical Resource
Stage
Draft 3/13/07
Clinical Triage Guidelines during Pandemic Critical Resources Stage
Patients with
Influenza symptoms1
Clinic/Urgent Care
911: EMS
Public Health
Information line
Hospital triage center
Pandemic flu triage protocol2
(1)
Hospital admission
- Medical beds
- ICU beds
Ventilators
Critical care
- X-ray, laboratory
(3)
(2)
Influenza care center
- Intermediate care
IV & PO hydration
IV & PO antibiotics
Oxygen delivery
- Board and care
- Nursing services
- MD on site/on call
Home care
- Oral hydration
- Oral antibiotics
- Antipyretics
- PPE
- Isolation
Notes:
1. Influenza symptoms: High fever (T > 38) plus sore throat, cough or
shortness of breath. Other symptoms: weakness, malaise, myalgias,
chills, headache, nasal congestion, and (sometimes) abdominal
symptoms.
2. Pandemic flu triage protocol must consider:
Available resources: vital signs, examination, pulse oximetry
Patient: wears respiratory mask on presentation
Personnel: respiratory and universal precautions
Evaluation: age, living conditions, functional status, sick contacts
Other comorbid medical conditions
2
Draft 3/13/07
A. Adults and children >10 years of age AND > 25 kg (55 pounds):
modified pneumonia severity index (PSI) calculation
Characteristic
Points assigned
Highest risk age group(s) (to be determined) +10
Significant co-morbid illness1
+10
Physical exam
Altered mental status
+20
Respirations >30
+20
Systolic BP<90
+20
Pulse >125
+20
Room air pulse oximetry <92%
+20
(1) Admission to hospital: Score > 50 or
a. Toxic appearance or rapid decompensation (especially
important in adolescents and in pregnant women)
b. Significant hypoxia – O2 saturation in room air < 88%
1
For purposes of these triage guidelines, significant co-morbid illness would
include any of the following:














Pregnancy
Asthma requiring daily use of medications, or symptomatic at presentation,
Chronic lung disease, requiring oxygen or medications, or symptomatic at presentation,
Hemodynamically significant congenital heart disease,
Heart failure,
HIV infection with CD4 count < 200,
Patients on systemic steroid therapy equivalent to prednisone >15 mg/day for >1 month,
Severe rheumatological or autoimmune diseases,
Other immunocompromising conditions likely to result in life-threatening complications,
Renal patients requiring dialysis,
Cancer, currently on chemotherapy or radiation therapy,
Severe anemia with hemoglobin concentration < 10 gm/dl,
Hemoglobinopathies, such as sickle cell disease or thalassemia,
Chronic neurological disorders affecting the muscles of respiration, such as spinal cord
injuries, spastic quadriplegia, muscular dystrophy, etc.
3
Draft 3/13/07
(2) Admission to Influenza Care Center:2
a. Score > 50 and no hospital beds available, OR
b. Score < 50 and needs closer monitoring and nursing care
(for example, IV fluids, IV antibiotics, etc.), OR
c. Score < 50 and unable to care for self or return if
symptoms worsen.
(3) Discharge to home:
a. Score >50 with poor prognosis and unlikely to benefit
from hospitalization, or
b. Score < 50 and able to care for self or has caregiver, and
able to return if symptoms worsen.
B. Children under 10 yrs of age:
Indications for hospital admission include any of the following
a. Fever and age < 3 months
b. Significant tachypnea
c. Hypoxia on pulse oximetry
d. Chest retractions, cyanosis, intermittent apnea, nasal
flaring
e. Toxic appearance
The plan is currently pending for how to provide care to children
who meet criteria for hospital admission when no pediatric hospital
beds are available.
2
Persons with the following conditions can not be accommodated at an Influenza Care Center
(due to staffing ratios, equipment, or supply limitations), regardless of their score:
 Age < 10 yrs
 Weight > 300 lbs (ICC cot weight limit is 300 lbs)
 Asthma exacerbation or other condition requiring respiratory support
 Congenital heart disease on oxygen
 Unstable angina
 Pregnant with condition requiring hospital care or within one week of due date
 Cirrhosis with ascites
 Chronic renal failure on dialysis
 Acute immunosuppressing condition (acute leukemia, s/p bone marrow transplant, etc)
 Sickle cell disease
 HIV with CD4 < 200
 Mental status precluding care with minimal staffing (dementia, psychosis, delirium,
suicidality, homocidality)
 Acute alcohol or drug withdrawal, or on methadone maintenance
 Severe mobility impairment (from neuromuscular disorder or otherwise)
4