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

Authors

  • Madhuri M. Sopirala MD, MPH,

    Corresponding author
    1. Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio
    2. Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
    3. Department of Infection Control and Antimicrobial Stewardship, University of Cincinnati, Cincinnati, Ohio
    • Division of Infectious Diseases, University of Cincinnati Health System, 234 Goodman St, 140 Mont Reid, Cincinnati, OH 45219
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    • Telephone: 513-558-4704; Fax: 513-558-2089

  • Douglas M. Haas MD,

    1. Division of Infectious Diseases, Ohio State University Medical Center, Columbus, Ohio
    2. Department of Internal Medicine, Ohio State University Medical Center, Columbus, Ohio
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  • Naeem A. Ali MD,

    1. Department of Internal Medicine, Ohio State University Medical Center, Columbus, Ohio
    2. Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Ohio State University Medical Center, Columbus, Ohio
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  • Julie E. Mangino MD,

    1. Division of Infectious Diseases, Ohio State University Medical Center, Columbus, Ohio
    2. Department of Internal Medicine, Ohio State University Medical Center, Columbus, Ohio
    3. Department of Clinical Epidemiology, Ohio State University Medical Center, Columbus, Ohio
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  • Xueliang Pan PhD,

    1. Center for Biostatistics, Ohio State University Medical Center, Columbus, Ohio
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  • Abigail Norris Turner PhD

    1. Division of Infectious Diseases, Ohio State University Medical Center, Columbus, Ohio
    2. Department of Internal Medicine, Ohio State University Medical Center, Columbus, Ohio
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  • Disclosures: J.E.M. received a research grant to study ultraviolet disinfection from Medline Industries Inc, and honorariums for lectures at Making a Difference in Infectious Diseases Pharmacotherapy (MAD-ID). M.M.S. received royalties from UpToDate® for a contribution to “Pathogenesis of Osteomyelitis,” and from the Infectious Diseases Society of America (IDSA) for serving as an Interactive Panelist for the Clinical Interactive Session.

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. © 2012 Society of Hospital Medicine

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