Physiological-social score (PMEWS) vs. CURB-65 to triage pandemic influenza: a comparative validation study using community-acquired pneumonia as a proxy

BMC Health Serv Res. 2007 Mar 1:7:33. doi: 10.1186/1472-6963-7-33.


Background: An influenza pandemic may increase Emergency Department attendance 7-fold. In the absence of a validated "flu score" to assess severity and assist triage decisions from primary into secondary care, current UK draft management recommendations have suggested the use of CURB-65 and chest X-ray as a proxy. We developed the Pandemic Medical Early Warning Score (PMEWS) to track and triage flu patients, taking into account physiological and social factors and without requiring laboratory or radiology services.

Methods: Validation of the PMEWS score against an unselected group of patients presenting and admitted to an urban UK teaching hospital with community acquired pneumonia. Comparison of PMEWS performance against CURB-65 for three outcome measures: need for admission, admission to high dependency or intensive care, and inpatient mortality using area under ROC curve (AUROC) and the Hanley-McNeil method of comparison.

Results: PMEWS was a better predictor of need for admission (AUROC 0.944) and need of higher level of care (AUROC 0.83) compared with CURB-65 (AUROCs 0.881 and 0.640 respectively) but was not as good a predictor of subsequent inpatient mortality (AUROC 0.663).

Conclusion: Although further validation against other disease datasets as a proxy for pandemic flu is required, we show that PMEWS is rapidly applicable for triage of large numbers of flu patients to self-care, hospital admission or HDU/ICU care. It is scalable to reflect changing admission thresholds that will occur during a pandemic.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Community-Acquired Infections / classification
  • Community-Acquired Infections / diagnosis*
  • Community-Acquired Infections / epidemiology
  • Critical Care / statistics & numerical data
  • Disaster Planning
  • Disease Outbreaks*
  • Emergency Service, Hospital / organization & administration
  • Emergency Service, Hospital / statistics & numerical data*
  • Health Planning*
  • Hospitals, University / statistics & numerical data
  • Humans
  • Influenza, Human / classification
  • Influenza, Human / diagnosis*
  • Influenza, Human / epidemiology*
  • Middle Aged
  • Patient Admission / statistics & numerical data
  • Pneumonia / classification
  • Pneumonia / diagnosis*
  • Pneumonia / epidemiology
  • Public Health Administration*
  • Retrospective Studies
  • Self Care / statistics & numerical data
  • Sentinel Surveillance*
  • Severity of Illness Index*
  • Triage / methods*
  • United Kingdom / epidemiology