Clinico-Radiological Profile, Polymerase Chain Reaction (PCR)- Positivity and Outcome - Analysis in Hospitilized Suspected H1N1 Pneumonia; Efficiency Assessment of health care delivery system. A Pilot Study
Background:H1N1 pneumonia has been posing a serious public health challenge globally since 2009. The pneumonia is a serious disease, not only difficult to diagnose but also commonly leads to a fatal outcome.Aims and Objectives:The main objective was to determine possible factors predicting PCR-positivity and a fatal outcome. Another aim was to assess the efficacy of healthcare delivery system.Material and Methods: This was a prospective, descriptive study conducted at the Lady Reading Hospital, Peshawar, fromOctober 2015 to February 2016. The data was collected and recorded on a preset, structured data-collection form.Results: Out of the total 145 suspected cases, 37 were selected for the study. The baseline characteristics studied were age, gender, pregnancy status, urban/rural residence, symptoms and signs, time to admission, radiological findings, oxygen saturation, need for ventilatory support, PCR-positivity and non-fatal/fatal outcome. The overall PCR-positivity and fatality was 11 (29.7%) and 14 (37.8%) respectively. The only factor which could predict a positivePCR and was statistically significant, was bilateral mid and lower zone consolidation on CXR, 10 out of 26 (38.5%) cases as compared to 01 out of 11 (9.1%) cases among other CXR findings (P= 0.00023). The factors associated with high fatality were hypoxia (oxygen saturation <80%) and the need for invasive ventilation, each associated with 09 out of 15 (60%) fatalities (P= 0.0217) and 14 out of 15 (93.3%) fatalities (P= 0.0007) respectively. No patient was previously flu-vaccinated. Majority (56.8%) of the patients were admitted after 5 days of symptom onset. PCR-diagnostic facility was provided to 25.5% of the suspected cases. Ventilatory support was provided to less than half (46.7%) of the total cases needing invasive ventilation. Oseltamivir treatment (both free and self-sponsored) was provided to only 59.5% cases.Conclusion: Proper patient selection can yield a greater PCR-positive casedetection in H1N1 pneumonia as it is a serious disease with high mortality, improvement needs to be brought at all levels for prevention and early diagnosis to timely treatment.
