• R J Commons and J Denholm.
• Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia.
• Int. J. Tuberc. Lung Dis. 2012 May 1;16(5):670-3.

SettingThe 2009 H1N1 influenza pandemic caused significant strain on health systems worldwide. A tool to triage patients at low risk of requiring intensive care services would assist practitioners in safely reducing hospital admission rates during pandemic influenza outbreaks. Community-acquired pneumonia severity scores have not been validated for use in pandemic influenza.ObjectiveTo assess the accuracy of the pneumonia severity index (PSI), CURB-65 and SMRT-CO severity scores in predicting patients at low risk of requiring intensive care services.DesignBetween May and July 2009, 105 patients admitted with laboratory-confirmed pandemic (H1N1) 2009 influenza to Melbourne public hospitals were assessed on admission to determine their pneumonia severity scores and subsequent need for intensive care unit (ICU) support and length of stay.ResultsSMRT-CO was the most accurate score at predicting ICU admission, with an area under the curve of the receiver operating characteristic of 0.826. No score provided good discrimination of low-risk patients, with respectively 19%, 21% and 12% requiring ICU admission as predicted by PSI, CURB-65 and SMRT-CO.ConclusionCurrent pneumonia severity scores have insufficient predictive ability to safely identify low-risk patients with pandemic (H1N1) 2009 influenza.

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