• Te-Hao Wang, Jing-Cheng Jheng, Yen-Ting Tseng, Li-Fu Chen, and Jui-Yuan Chung.
• Department of Emergency Medicine, National Yang Ming Chiao Tung University Hospital, Ilan, Taiwan.
• BMJ Open. 2021 Jun 11; 11 (6): e044496.

ObjectiveDuring the influenza epidemic season, the fragile elderlies are not only susceptible to influenza infections, but are also more likely to develop severe symptoms and syndromes. Such circumstances may pose a significant burden to the medical resources especially in the emergency department (ED). Disposition of the elderly patients with influenza infections to either the ward or intensive care unit (ICU) accurately is therefore a crucial issue.Study DesignRetrospective cohort study.Setting And ParticipantsElderly patients (≥65 years) with influenza visiting the ED of a medical centre between 1 January 2010 and 31 December 2015.Primary Outcome MeasuresDemographic data, vital signs, medical history, subtype of influenza, national early warning score (NEWS) and outcomes (mortality) were analysed. We investigated the ability of NEWS to predict ICU admission via logistic regression and the receiver operating characteristic (ROC) analysis.ResultsWe included 409 geriatric patients in the ED with a mean age of 79.5 years and approximately equal sex ratio. The mean NEWS ±SD was 3.4±2.9, and NEWS ≥8 was reported in 11.0% of the total patients. Logistic regression revealed that NEWS ≥8 predicted ICU admission with an OR of 5.37 (95% CI 2.61 to 11.04). The Hosmer-Lemeshow goodness-of-fit test was calculated as 0.95, and the adjusted area under the ROC was 0.72. An NEWS ≥8 is associated with ICU-admission and may help to triage elderly patients with influenza infections during the influenza epidemic season.ConclusionThe high specificity of NEWS ≥8 to predict ICU admission in elderly patients with influenza infection during the epidemic season may avoid unnecessary ICU admissions and ensure proper medical resource allocation.© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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