CDC Influenza Season Triage Algorithm for Adults (>18 Years)

With Influenza-Like Illness


This algorithm is meant for use by healthcare professionals and their surrogates, not by the general public. This algorithm applies regardless of whether or not the patient has been vaccinated for influenza. Patients who do not have all the signs/symptoms (and therefore are not eligible for the algorithm) are encouraged to seek care or talk to a healthcare provider about their illness.
 

Are all of the following present?

  • Age greater than 18
  • Fever or feverishness*
  • Cough or sore throat
  • No other symptoms

* If antipyretics are taken this may inhibit a patient’s ability to mount a fever

No → Although influenza cannot be ruled out in this patient, this algorithm should not be used to guide clinical decision making in this case. Advise patient to contact their healthcare provider for advice about their current illness. Many people with influenza illness will not have a fever. Other symptoms of influenza can include chills, body aches/muscle pain, headache, fatigue, runny nose, and occasionally diarrhea and vomiting


 
Yes
   
  Are any of the following signs or symptoms present?†
• Difficulty breathing or shortness of breath
• Pain or pressure in the chest
• Dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms improved but then return or worsen within a
few days

† These symptoms are purposely broad to minimize the possibility of misclassifying people who truly have severe disease. The person attempting to triage the patient should take into account the severity and duration of the symptoms and the patient’s ability to care for themselves or access a reliable caregiver when deciding whether or not patients should be advised to seek care immediately.
Yes → This patient should be advised to seek medical care immediately
 
No
   
 

Is the patient:

• Age 65 years or older

OR

• Pregnant This patient is at higher risk for influenza complications. The patient should be advised to contact their healthcare provider to discuss antiviral treatment that day. Providers may advise such patients to take antiviral medications for treatment and/or other therapy. Early use of influenza antiviral medications can reduce the risk of influenza- related complications

OR are any of the following comorbid conditions present:

• Chronic pulmonary (including asthma), cardiovascular (except isolated hypertension), renal, hepatic, hematological (including sickle cell disease), or metabolic disorders (including diabetes mellitus)
• Disorders that that can compromise respiratory function or the
handling of respiratory secretions or that can increase the risk for
aspiration (e.g., cognitive dysfunction, spinal cord injuries, seizure
disorders, or other neuromuscular disorders)
• Immunosuppression, including that caused by medications or by HIV

Note: obese patients and morbidly obese patients should be carefully evaluated
for the presence of underlying medical conditions that are known to increase
the risk for influenza complications, and receive empiric treatment when these
conditions are present, or if signs of lower respiratory tract infection are present

Yes →




This patient is at higher risk for influenza complications. The patient should be advised to contact their healthcare provider to discuss antiviral treatment that day. Providers may advise such patients to take antiviral medications for treatment and/or other therapy. Early use of influenza antiviral medications can reduce the risk of influenza- related complications
 

No

   
 

Based on the information above, this patient is at low risk for influenza complications and may not require testing or treatment for influenza if their symptoms are mild. Should their symptoms worsen or if they are concerned about their health they should be advised to seek medical care.

In order to help prevent spread of influenza to others, these patients should be advised:

• To keep away from others to the extent possible, particularly those at higher risk for complications from influenza (see box next page).
This may include staying in a separate room with the door closed.
• To cover their coughs and sneezes
• Avoid sharing utensils
• Wash their hands frequently with soap and water or alcohol-based hand rubs
• Stay home until 24 hours after their fever is gone
More information available at: http://www.cdc.gov/h1n1flu/guidance_homecare.htm

   
       
 

Does patient live with a person at higher risk for complications of influenza including someone who is:

  • Age < 2 years or age 65 years or older
    OR
  • Pregnant
  • Or someone with any of the following comorbid conditions:
    • Chronic pulmonary (including asthma), cardiovascular (except isolated hypertension), renal, hepatic, hematological (including sickle cell disease), or metabolic disorders
      (including diabetes mellitus)
    • Disorders that that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders)
    • Immunosuppression, including that caused by medications or
      by HIV
    • Child less than 19 years old on chronic aspirin therapy
    • Obesity or morbid obesity with any of the comorbid conditions listed above
Yes → Household contacts who are at
higher risk for complications of
influenza should be advised to
contact their healthcare provider for
advice on steps they might need to
take to prevent infection

 

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