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The Utility of Preliminary Patient Evaluation in a Febrile Respiratory Infectious Disease Unit Outside the Emergency Department

Identifieur interne : 000B57 ( Main/Exploration ); précédent : 000B56; suivant : 000B58

The Utility of Preliminary Patient Evaluation in a Febrile Respiratory Infectious Disease Unit Outside the Emergency Department

Auteurs : Jun Sik Kang ; Hee Yoon ; Byung Woo Jhun ; Seong Mi Lim ; Eun Sil Ko ; Joo Hyun Park ; Sung Yeon Hwang ; Se Uk Lee ; Tae Rim Lee ; Won Chul Cha ; Tae Gun Shin ; Min Seob Sim ; Ik Joon Jo

Source :

RBID : PMC:5631788

Abstract

AbstractBackground

Acute respiratory illnesses are the leading cause of death from infectious diseases around the world, and occasional outbreaks of particularly virulent strains are can be public health disasters. Recently, a large outbreak of fatal Middle East respiratory syndrome-coronavirus (MERS-CoV) occurred following a single patient exposure in the emergency department (ED) of the Samsung Medical Center, a tertiary-care hospital in South Korea, which resulted in significant public health and economic burden.

After this outbreak, a febrile respiratory infectious disease unit (FRIDU) with a negative pressure ventilation system was constructed outside the emergency department (ED) in 2015, to screen for patients with contagious diseases requiring isolation.

Methods

This is a retrospective cohort study of patients who visited the ED with febrile illness between August 2015 and July 2016. Ultimately, 1562 patients who were hospitalized after FRIDU screening were analyzed. The level of isolation recommended during their screening at the FRIDU was compared with the level deemed appropriate given their final diagnosis.

Results

Of the 1562 patients screened at the FRIDU, 198 (13%) were isolated, 194 (12%) were reverse isolated, and 1170 (75%) were not isolated. While hospitalized, 97 patients (6%) were confirmed to have a contagious disease requiring isolation, such as tuberculosis; 207 patients (13%) were confirmed to be immunocompromised and to require reverse isolation, mainly due to neutropenia; and the remaining 1258 patients (81%) did not require isolation.

The correlation coefficient for isolation consistency was 0.565 (P < 0.001). No serious nosocomial outbreaks of contagious diseases occurred. During FRIDU screening, 114 patients were admitted to the resuscitation zone due to clinical instability, and three of these patients died.

Conclusion

The initial isolation levels resulting from FRIDU screening were moderately well correlated with the isolation levels required by the final diagnosis, demonstrating the utility of pre-hospitalization screening units. However, the risks of deterioration during the screening process remain challenges.

Disclosures

All authors: No reported disclosures.


Url:
DOI: 10.1093/ofid/ofx163.349
PubMed: NONE
PubMed Central: 5631788


Affiliations:

Links toward previous steps (curation, corpus...)

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,
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<addr-line>Seoul</addr-line>
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<country>Korea, Republic of (South)</country>
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<name sortKey="Ko, Eun Sil" sort="Ko, Eun Sil" uniqKey="Ko E" first="Eun Sil" last="Ko">Eun Sil Ko</name>
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<nlm:aff id="AF0001">
<institution>Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine</institution>
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<addr-line>Seoul</addr-line>
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<country>Korea, Republic of (South)</country>
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,
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,
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,
<addr-line>Seoul</addr-line>
,
<country>Korea, Republic of (South)</country>
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,
<addr-line>Seoul</addr-line>
,
<country>Korea, Republic of (South)</country>
</nlm:aff>
<wicri:regionArea># see nlm:aff region in country</wicri:regionArea>
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<name sortKey="Sim, Min Seob" sort="Sim, Min Seob" uniqKey="Sim M" first="Min Seob" last="Sim">Min Seob Sim</name>
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,
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,
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</nlm:aff>
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,
<addr-line>Seoul</addr-line>
,
<country>Korea, Republic of (South)</country>
</nlm:aff>
<wicri:regionArea># see nlm:aff region in country</wicri:regionArea>
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<title>Abstract</title>
<sec id="s1">
<title>Background</title>
<p> Acute respiratory illnesses are the leading cause of death from infectious diseases around the world, and occasional outbreaks of particularly virulent strains are can be public health disasters. Recently, a large outbreak of fatal Middle East respiratory syndrome-coronavirus (MERS-CoV) occurred following a single patient exposure in the emergency department (ED) of the Samsung Medical Center, a tertiary-care hospital in South Korea, which resulted in significant public health and economic burden.</p>
<p>After this outbreak, a febrile respiratory infectious disease unit (FRIDU) with a negative pressure ventilation system was constructed outside the emergency department (ED) in 2015, to screen for patients with contagious diseases requiring isolation.</p>
</sec>
<sec id="s2">
<title>Methods</title>
<p> This is a retrospective cohort study of patients who visited the ED with febrile illness between August 2015 and July 2016. Ultimately, 1562 patients who were hospitalized after FRIDU screening were analyzed. The level of isolation recommended during their screening at the FRIDU was compared with the level deemed appropriate given their final diagnosis.</p>
</sec>
<sec id="s3">
<title>Results</title>
<p>Of the 1562 patients screened at the FRIDU, 198 (13%) were isolated, 194 (12%) were reverse isolated, and 1170 (75%) were not isolated. While hospitalized, 97 patients (6%) were confirmed to have a contagious disease requiring isolation, such as tuberculosis; 207 patients (13%) were confirmed to be immunocompromised and to require reverse isolation, mainly due to neutropenia; and the remaining 1258 patients (81%) did not require isolation.</p>
<p>The correlation coefficient for isolation consistency was 0.565 (
<italic>P <</italic>
0.001). No serious nosocomial outbreaks of contagious diseases occurred. During FRIDU screening, 114 patients were admitted to the resuscitation zone due to clinical instability, and three of these patients died.</p>
</sec>
<sec id="s4">
<title>Conclusion</title>
<p> The initial isolation levels resulting from FRIDU screening were moderately well correlated with the isolation levels required by the final diagnosis, demonstrating the utility of pre-hospitalization screening units. However, the risks of deterioration during the screening process remain challenges.</p>
</sec>
<sec id="s5">
<title>Disclosures</title>
<p>
<bold>All authors:</bold>
No reported disclosures.</p>
</sec>
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