Original article| Volume 19, ISSUE 7, P494-498, November 2008

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Increased complaints of fever in the emergency room can identify influenza epidemics

Published:March 20, 2008DOI:



      In developing countries, it may be easier to use the reasons why patients come to the emergency room (ER) instead of sentinel practices to identify influenza epidemics.


      We studied the reasons why adult patients present to the ER in order to attempt to predict increased hospital activity as a result of influenza. The daily frequency of presenting symptoms during the 30 days of maximal influenza activity was compared to the other days of the study period (335 days).


      During the influenza period, more patients presented with fever, syncope or near syncope, cough, asthma attack, and paralysis than on the days outside of this period. On 50% of the days, eight or more patients presented with fever, an 8.36 (95% CI=4.6–15.19) higher frequency than during the rest of the year. During the subsequent year, days with excess presentations by patients with a principal complaint of fever predicted increased hospital activity due to influenza with no false-positive periods.


      We conclude that an increase in the number of patients presenting to the ER complaining of fever can identify increased hospital influenza activity.


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        • Hanratty B.
        • Robinson M.
        Coping with winter bed crises. New surveillance systems might help.
        BMJ. 1999; 319: 1511-1512
        • Dab W.
        • Quenel P.
        • Cohen J.M.
        • Hannoun C.
        A new influenza surveillance system in France: the Ile-de-France, “GROG”. 2. Validity of indicators (1984–1989).
        Eur J Epidemiol. 1991; 7: 579-587
        • Quernel P.
        • Dab W.
        • Hannoun C.
        • Cohen J.M.
        Sensitivity, specificity and predictive values of health service based indicators for the surveillance of influenza A epidemics.
        Int J Epidemiol. 1994; 23: 849-855
        • Silka P.A.
        • Geiderman J.M.
        • Goldberg J.B.
        • Kim L.P.
        Demand on ED resources during periods of widespread influenza activity.
        Amer J of Emerg Med. 2003; 21: 534-539
        • Irvin C.B.
        • Nouhan P.P.
        • Rice K.
        Syndromic analysis of computerized emergency department patients' chief complaints: an opportunity for bioterrorism and influenza surveillance.
        Ann Emerg Med. 2003; 41: 447-452
        • Brillman J.C.
        • Burr T.
        • Forslung D.
        • Joyce E.
        • Picard R.
        • Umland E.
        Modeling emergency department visit patterns for infectious disease complaints: results and application to disease surveillance.
        BMC Med Inform Decis Mak. 2005; 5 ( 4-18
        • Heffernan R.
        • Mostashari F.
        • Das D.
        • Karpati A.
        • Kulldorff M.
        • Weiss D.
        Syndromic surveillance in public health practice, New York City.
        Emerg Infect Dis. 2004; 10: 858-864
        • Steiner-Sichel L.
        • Greenko J.
        • Heffernan R.
        • Layton M.
        • Weiss D.
        Field investigations of emergency department syndromic surveillance signals—New York City.
        MMWR Morb Mortal Wkly Rep. 2004; 53 (suppl): 184-189
        • Terry W.
        • Ostrowsky B.
        • Huang A.
        Should we be worried? Investigation of signal generated by an electronic syndromic surveillance system—Westchester County, New York.
        MMWR Morb Mortal Wkly Rep. 2004; 53 (suppl): 190-195
        • Shimoni Z.
        • Gershon A.
        • Kama N.
        • Dusseldorp N.
        • Froom P.
        Reasons patients present to the emergency department might change during epidemics and be a valuable component of a disease surveillance system.
        Med Hypotheses. 2006; 67: 709-712
      1. Israel Center for Disease Control. Surveillance of influenza-like illness in Israel. Summary report of the influenza season 2003-2004. Ministry of Health, Israel.

      2. Israel Center for Disease Control. Surveillance of influenza-like illness in Israel. Summary report of the influenza season 2004-2005. Ministry of Health, Israel.

        • Monmany J.
        • Rabella N.
        • Margall N.
        • Domingo P.
        • Gich I.
        • Vazquez G.
        Unmasking influenza virus infection in patients attended to in the emergency department.
        Infection. 2004; 32: 89-97
        • Liu T.
        • Sayre M.R.
        • Careton S.C.
        Emergency medical care: types, trends and factors related to non-urgent visits.
        Acad Emerg Med. 1999; 6: 1147-1152
        • Lang T.
        • Davido A.
        • Diakite B.
        • Agay E.
        • Viel J.F.
        • Flicoteaux B.
        Non-urgent care in the hospital medical emergency department in France: how much and which health needs does it reflect?.
        J Epidemiol Community Health. 1996; 50: 456-462
        • Gill J.M.
        Non-urgent use of the emergency department: appropriate or not?.
        Ann Emerg Med. 1994; 24: 953-957