SORTing out symptoms of H1N1


When the first wave of the H1N1 virus hit last summer, people with flu symptoms began trickling into emergency departments across the country.

Doctors knew that crowded waiting rooms could make the problem worse. People sick with H1N1 could infect others, speeding the overall rate of infection.

Many emergency departments were overloaded already, and an emerging pandemic could further weaken the health care system. Getting information out to a confused public was vital. People needed to know what symptoms constitute H1N1 versus seasonal flu. If flu symptoms were present, was a trip to the hospital or a primary care doctor necessary? 

The first online tool to help answer questions like this is now available. People enter their age and answer a few questions about their symptoms and, voilà, a recommendation pops up about the level of care they should seek. The questions and recommendations are based on an algorithm developed by two Emory emergency physicians more than a year ago—long before H1N1 arrived on the scene. 

The algorithm is SORT —strategy for off-site rapid triage, and it was designed to aid in a public health emergency. It uses three sets of questions to determine if patients meet the criteria for an illness, to gather information about symptoms, and to record responses about general health. Based on the answers, a person is placed into one of three categories: high risk (needs immediate medical attention), intermediate risk (can see a doctor for evaluation), or low risk (can recover at home or administer self-care).

SORT was crafted as a way to manage the surge if large numbers of people suddenly entered the health system, says Emory emergency medicine specialist Alex Isakov, director of Emory’s Office of Critical Event Preparedness and Response. “The goal was to identify the most severely ill, while redirecting large numbers of symptomatic people away from crowded hospitals without compromising their care.”

Isakov and colleagues developed SORT in 2008. They tapped Emory health literacy expert Ruth Parker, who helped test the wording of SORT questions with more than 100 people of various ages and socioeconomic backgrounds in several cities. Among her findings: people better understand “pee” than “urinate,” and college students rarely know their body temp.

After tweaking the H1N1 SORT questions, Emory offered the tool free of charge. Microsoft hosted the H1N1 website for free, and the CDC and the U.S. Department of Health and Human Services used slightly modified versions of SORT on their websites. The registered nurses who answer calls at Emory HealthConnection used a paper version of SORT for questions about H1N1. 

So far, the website,, has received more than 1 million hits. Experts can quickly update information online when new findings about the virus strain become available. “This tool isn’t static, and it shouldn’t be,” Isakov says.  “SORT allows you to 'dial up' or 'dial down' how conservative the tool will be depending on circumstances of the pandemic.” —Kay Torrance

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