Local influenza-like illness surveillance at a university health system during the 2009 H1N1 influenza pandemic.

BACKGROUND: The 2009 novel H1N1 influenza epidemic generated interest in regional and national influenza surveillance methods. Some systems revamped traditional syndromic and laboratory surveillance techniques, whereas others tracked influenza by Internet-based searches or other unique methods. We hypothesized that an influenza-like illness (ILI) surveillance system at a single university hospital would be accurate and useful for monitoring local influenza activity and impact. METHODS: We developed a system of ILI surveillance at 8 sentinel sites associated with a university health care system before the pandemic 2009-10 influenza season. Most sentinel sites used a symptom-based definition of ILI, whereas others used electronic medical records-based definitions. RESULTS: Results of the local ILI surveillance network correlated well with the onset and peak of the influenza season compared with state and regional ILI data, closely approximated cases of microbiologically confirmed influenza, demonstrated early onset of illness in one site in the sentinel site network, and were available several days sooner than data from existing surveillance systems. CONCLUSIONS: Local influenza surveillance at a single-institution level provided timely, useful, and accurate information, which helped guide resource utilization during the pandemic influenza season. The system was an important supplement to state and regional influenza surveillance.

In-hospital cardiac arrest: impact of monitoring and witnessed event on patient survival and neurologic status at hospital discharge.

CONTEXT: In-hospital cardiac arrest is a significant public health problem with a low probability of patient survival to hospital discharge. OBJECTIVE: We evaluated the survival rates for adults with in-hospital cardiac arrest based on whether the arrest was witnessed and/or monitored. Our hypothesis is that patients with either a witnessed or monitored arrest had improved survival to hospital discharge with intact neurologic function. DESIGN, SETTING, AND PATIENTS: We studied a cohort study of 74,213 patients who suffered in-hospital cardiac arrest from January 1, 2000 through February 1, 2008 at the 369 hospitals participating in the National Registry of Cardiopulmonary Resuscitation. INTERVENTIONS: The primary exposure of interest was whether the arrest was witnessed and/or monitored (i.e. electrocardiography, pulse oximetry, apnea, or bradycardia monitoring) at the time of arrest. Events were classified as being both monitored and witnessed, monitored only, witnessed only, or neither witnessed nor monitored. MAIN OUTCOME MEASURES: Survival to hospital discharge and cerebral performance category at time of discharge. RESULTS: A total of 73% of patients suffering in-hospital cardiac arrest were witnessed and monitored; 10% were monitored but not witnessed; 9% were witnessed but not monitored; and 8% were neither witnessed nor monitored. Compared with those who were unmonitored/unwitnessed, each of the three groups of patients who were monitored and/or witnessed were over twice as likely to survive to hospital discharge with a cerebral performance category of 1 or 2 (monitored/witnessed OR=2.40, 95% CI: 2.08, 2.76; monitored-only OR=2.12, 95% CI: 1.81, 2.47; witnessed-only OR=2.43, 95% CI: 2.10, 2.83). CONCLUSIONS: Patients who are witnessed and/or monitored at the time of cardiac arrest demonstrate a significantly higher rate of survival to hospital discharge compared to those patients who are neither monitored nor witnessed. Monitored and/or witnessed cardiac arrest patients were also more likely to be discharged with favorable neurologic outcome. Cardiac monitoring confers no additional outcome benefit over direct observation of patients suffering in-hospital cardiac arrest.