Emergency Physicians’ Adherence to Center for Disease Control and Prevention Guidance During the 2009 Influenza A H1N1 Pandemic

INTRODUCTION: Little is known regarding compliance with management guidelines for epidemic influenza in adult emergency department (ED) settings during the 2009 novel influenza A (H1N1) epidemic, especially in relation to the Centers for Disease Control and Prevention (CDC) guidance. METHODS: We investigated all patients with a clinical diagnosis of influenza at an inner-city tertiary academic adult ED with an annual census of approximately 60,000 visits from May 2008 to December 2009. We aimed to determine patterns of presentation and management for adult patients with an ED diagnosis of influenza during the H1N1 pandemic, using seasonal influenza (pre-H1N1) as reference and to determine the ED provider’s adherence to American College of Emergency Physicians and CDC guidance during the 2009 H1N1 influenza pandemic. Adherence to key elements of CDC 2009 H1N1 guidance was defined as (1) the proportion of admitted patients who were recommended to receive testing or treatment who actually received testing for influenza or treatment with antivirals; and (2) the proportion of high-risk patients who were supposed to be treated who actually were treated with antivirals. RESULTS: Among 339 patients with clinically diagnosed influenza, 88% occurred during the H1N1 pandemic. Patients were similarly managed during both phases. Median length of visit (pre-H1N1: 385 min, H1N1: 355 min, P > 0.05) and admission rates (pre-H1N1: 8%, H1N1: 11%, P > 0.05) were similar between the 2 groups. 28% of patients in the pre-H1N1 group and 16% of patients in the H1N1 group were prescribed antibiotics during their ED visits (P > 0.05). There were 34 admitted patients during the pandemic;, 30 (88%) of them received influenza testing in the ED, and 22 (65%) were prescribed antivirals in the ED. Noticeably, 19 (56%) of the 34 admitted patients, including 6 with a positive influenza test, received antibiotic treatment during their ED stay. CONCLUSION: During the recent H1N1 pandemic, most admitted patients received ED diagnostic testing corresponding to the current recommended guidance. Antibiotic treatment for ED patients admitted with suspected influenza is not uncommon. However, less than 70% of admitted patients and less than 50% of high-risk patients were treated with antivirals during their ED visit, indicating a specific call for closer adherence to guidelines in future influenza pandemics.