Impact of seasonal and pandemic influenza on emergency department visits, 2003-2010, Ontario, Canada.
Impact of seasonal and pandemic influenza on emergency department visits, 2003-2010, Ontario, Canada.
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DOI：
10.1111/acem.12111
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发表时间：
2013-04
期刊：
影响因子：
--
通讯作者：
Schwartz B
中科院分区：
文献类型：
--
作者：
Schanzer DL;Schwartz B
每周流感样疾病 (ILI) 咨询率是流感监测的一个组成部分。然而，在大多数医疗机构中，只有一小部分真正的流感病例被临床诊断为流感或流感样疾病。本研究的主要目的是估计因季节性和大流行性流感而前往急诊科 (ED) 就诊的次数和比率，并按年龄、诊断类别和就诊处置描述流感对 ED 的影响。第二个目标是评估每周“实时”时间序列的 ILI 急诊就诊，作为流感造成的全部负担的指标。作者对 2003 年 9 月至 2010 年 3 月期间从加拿大安大略省国家门诊护理报告系统 (NARCS) 数据库中提取的急诊室记录进行了生态学分析，并按诊断特征（国际疾病分类，第十版 [ICD-10]）、年龄和就诊倾向进行分层。使用回归模型来估计季节性基线。每周因流感导致的急诊就诊次数计算为统计模型预测的每周就诊次数与估计基线之间的差值。 2009 年 H1N1 流感大流行期间，因流感而就诊的估计急诊室就诊率有所上升，达到每 100,000 人 1,000 人（95% 置信区间 [CI] = 920 至 1,100），而季节性流感的年平均比率为每 100,000 人 500 人（95% CI = 450 至 550）。其中 2.6 次（38%）和 14 次（7%）中分别有 1 次和 1 次被临床诊断为 ILI 或流感。虽然 ILI 或临床流感诊断是针对流感最具体的诊断，但临床诊断的大流行性流感和季节性流感的 ILI 或流感就诊中，分别只有 87% 和 58% 可能直接由流感感染引起。年轻群体的 ILI 急诊就诊率最高，而老年人入院的可能性最高。在季节性流感活动期间，登记有非呼吸道疾病症状但无人发现而离开的人数显着增加。这种影响在 2009 年大流行期间更为明显。流感引起的呼吸道疾病就诊与流感引起的流感样疾病就诊的比例从 2009 年秋季 H1N1 浪潮的 2.4:1 到 2003/04 甲型流感 (H3N2) 季节的 9:1 和 2007/08 H1N1 季节的 28:1 不等。流感对急诊就诊的影响似乎比流感或流感样疾病临床诊断所产生的影响要大得多。在整个研究期间，ILI 急诊就诊与过度呼吸系统主诉密切相关。然而，ILI 急诊就诊与流感对急诊就诊的估计影响之间的关系每年都不够一致，不足以预测流感对急诊或下游院内资源需求的影响。
Weekly influenza-like illness (ILI) consultation rates are an integral part of influenza surveillance. However, in most health care settings, only a small proportion of true influenza cases are clinically diagnosed as influenza or ILI. The primary objective of this study was to estimate the number and rate of visits to the emergency department (ED) that are attributable to seasonal and pandemic influenza and to describe the effect of influenza on the ED by age, diagnostic categories, and visit disposition. A secondary objective was to assess the weekly “real-time” time series of ILI ED visits as an indicator of the full burden due to influenza. The authors performed an ecologic analysis of ED records extracted from the National Ambulatory Care Reporting System (NARCS) database for the province of Ontario, Canada, from September 2003 to March 2010 and stratified by diagnostic characteristics (International Classification of Diseases, 10th Revision [ICD-10]), age, and visit disposition. A regression model was used to estimate the seasonal baseline. The weekly number of influenza-attributable ED visits was calculated as the difference between the weekly number of visits predicted by the statistical model and the estimated baseline. The estimated rate of ED visits attributable to influenza was elevated during the H1N1/2009 pandemic period at 1,000 per 100,000 (95% confidence interval [CI] = 920 to 1,100) population compared to an average annual rate of 500 per 100,000 (95% CI = 450 to 550) for seasonal influenza. ILI or influenza was clinically diagnosed in one of 2.6 (38%) and one of 14 (7%) of these visits, respectively. While the ILI or clinical influenza diagnosis was the diagnosis most specific to influenza, only 87% and 58% of the clinically diagnosed ILI or influenza visits for pandemic and seasonal influenza, respectively, were likely directly due to an influenza infection. Rates for ILI ED visits were highest for younger age groups, while the likelihood of admission to hospital was highest in older persons. During periods of seasonal influenza activity, there was a significant increase in the number of persons who registered with nonrespiratory complaints, but left without being seen. This effect was more pronounced during the 2009 pandemic. The ratio of influenza-attributed respiratory visits to influenza-attributed ILI visits varied from 2.4:1 for the fall H1N1/2009 wave to 9:1 for the 2003/04 influenza A(H3N2) season and 28:1 for the 2007/08 H1N1 season. Influenza appears to have had a much larger effect on ED visits than was captured by clinical diagnoses of influenza or ILI. Throughout the study period, ILI ED visits were strongly associated with excess respiratory complaints. However, the relationship between ILI ED visits and the estimated effect of influenza on ED visits was not consistent enough from year to year to predict the effect of influenza on the ED or downstream in-hospital resource requirements.
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