Technical and Alarm signs for referral in adult patients with acute febrile illness: A study from a tertiary care hospital in North India

CONTEXT: There is a huge burden of patients with acute febrile illness (AFI) during the post-monsoon season in India. It is very important to have a functioning triage system, whereby patients with high likelihood of developing a severe illness are referred to higher levels of care. AIM: The objective of this study was to identify the alarm signs which would help in triaging of those patients with AFI without any specific diagnosis. METHODS: This was a retrospective review of records, whereby clinical and laboratory parameters of patients with AFI admitted in our tertiary care center between July 2016 and October 2016 were reviewed. STATISTICAL ANALYSIS USED: Appropriate tests of significance were applied using SPSS 21(Chicago, IL, USA) to find statistically significant differences between those who required mechanical ventilation, intensive care, ionotropic support, or higher intravenous antibiotics and those who recovered with minimal supportive care. RESULTS: Presence of comorbidities, dyspnea, altered sensorium, features of myocarditis, hypotension, leukocytosis (>11,000/μL), and acute kidney injury were significantly associated with requirement of higher levels of care, while presence of arthralgia, serositis, and leucopenia indicated a higher likelihood of recovery with minimal support. CONCLUSION: This article highlights the possibility of identification of simple alarm signs in patients with AFI which would indicate the need for higher levels of care.