Effect of fever on hospital presentation, diagnosis, and treatment in patients with H1N1/09 influenza

Madhuri M. Sopirala, Douglas M. Haas, Naeem A. Ali, Julie E. Mangino, Xueliang Pan, Abigail Norris Turner

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: Fever is typically considered part of the influenza-like illness in hemagglutinin type 1 and neuraminidase type 1 (H1N1/09) influenza. We assessed the proportion of patients that did not have fever as part of their illness prior to hospital presentation. We assessed the role of fever on the delay in hospital presentation, diagnosis, and treatment of these patients. Methods: We performed a retrospective analysis of all hospitalized adult patients with laboratory-confirmed pandemic H1N1/09 at a tertiary care center in the United States from June 1 to December 31, 2009. Results: Fifty-six of 135 study patients (42%) had no fever; 31 (23%) required intensive care unit (ICU) admission, and 9 (7%) died. Those without fever had higher Charlson index (P = 0.01), significantly longer time to hospital presentation (median 4 vs 2 days, P < 0.001), longer time to treatment since the onset of illness (median 5 vs 2 days, P = 0.001), and were more frequently in an ICU (P = 0.01). After adjustment for age (<40 vs ≥40) and Charlson index (0, 1-2, ≥3), patients without fever had significantly increased likelihood of late hospital presentation (>2 days from the onset of illness) (P = 0.001) and also had increased likelihood of ICU stay (P = 0.05). Conclusions: Forty-two percent of patients with laboratory-confirmed H1N1/09 did not have fever as part of their illness prior to hospital presentation. Patients without fever had delayed presentation to the hospital and thus experienced delayed treatment. Journal of Hospital Medicine 2013.

Original languageEnglish (US)
Pages (from-to)20-24
Number of pages5
JournalJournal of hospital medicine
Volume8
Issue number1
DOIs
StatePublished - Jan 1 2013
Externally publishedYes

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Human Influenza
Fever
Therapeutics
Intensive Care Units
Hospital Medicine
Sick Leave
Neuraminidase
Pandemics
Tertiary Care Centers

ASJC Scopus subject areas

  • Leadership and Management
  • Internal Medicine
  • Fundamentals and skills
  • Health Policy
  • Care Planning
  • Assessment and Diagnosis

Cite this

Effect of fever on hospital presentation, diagnosis, and treatment in patients with H1N1/09 influenza. / Sopirala, Madhuri M.; Haas, Douglas M.; Ali, Naeem A.; Mangino, Julie E.; Pan, Xueliang; Turner, Abigail Norris.

In: Journal of hospital medicine, Vol. 8, No. 1, 01.01.2013, p. 20-24.

Research output: Contribution to journalArticle

Sopirala, Madhuri M. ; Haas, Douglas M. ; Ali, Naeem A. ; Mangino, Julie E. ; Pan, Xueliang ; Turner, Abigail Norris. / Effect of fever on hospital presentation, diagnosis, and treatment in patients with H1N1/09 influenza. In: Journal of hospital medicine. 2013 ; Vol. 8, No. 1. pp. 20-24.
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