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Appendix 10: Admission and discharge guidance for an influenza-like illness
Further details on the clinical management of patients with an influenza-like illness during an influenza pandemic are available in: Clinical guidelines for patients with an influenza like illness during an influenza pandemic. 69 The use of any severity assessment tool does not replace clinical judgment. A patient's social circumstances should also always be taken in to account.
a) Admission guidance - adults
Patients with new or worsening symptoms - particularly shortness or breath or recrudescent fever not responding to treatment - should be examined to assess the presence and severity of influenza-related pneumonia.
- Patients with worsening of pre-existing co-morbid medical conditions should be managed according to best practice for that condition with reference to published disease-specific guidelines, if available.
- In patients with influenza-related pneumonia clinically, hospital referral and assessment should be considered for patients with a CRB-65 score of 1 or 2 (particularly score 2) and urgent admission for those with CRB-65 score of 3 or more.
- Patients with bilateral chest signs of pneumonia should be referred to hospital for further assessment regardless of CRB-65 score.
- The CRB-65 score does not replace clinical judgment.
b) Admission guidance - children
Children who are severely ill should be referred for assessment for admission. Indicators of severe disease are:
- cyanosis
- severe dehydration
- altered conscious level
- complicated or prolonged seizures
- signs of sepsis such as extreme pallor, hypotension, a floppy infant
- signs of respiratory distress such as markedly raised respiratory rate, grunting, intercostal recession or breathlessness with chest signs.
c) Discharge guidance - adults
Patients should be reviewed before 24 hours of discharge home. Those with two or more of the following unstable clinical factors should be considered for continued hospital management:
- temperature >37.8C
- heart rate >100/min
- respiratory rate > 24/min
- systolic blood pressure <90mmHg
- oxygen saturation <90%
- inability to maintain oral intake
- abnormal mental status.
d) Discharge guidance - children
All children should be assessed for discharge at least twice daily. Children should not remain in hospital if they are receiving therapy that could be given in the community. In previously healthy children, suitable discharge criteria would be if the child:
- is clearly improving
- is physiologically stable
- can tolerate oral feeds
- has a respiratory rate of <40/min (<50/min in infants)
- has awake oxygen saturation of >92% on air.
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