Diagnostic delays in Middle East respiratory syndrome coronavirus patients and health systems
Identifieur interne : 000341 ( Pmc/Checkpoint ); précédent : 000340; suivant : 000342Diagnostic delays in Middle East respiratory syndrome coronavirus patients and health systems
Auteurs : Anwar E. Ahmed [Arabie saoudite]Source :
- Journal of Infection and Public Health [ 1876-0341 ] ; 2019.
Abstract
Although Middle East respiratory syndrome coronavirus (MERS-CoV) diagnostic delays remain a major challenge in health systems, the source of delays has not been recognized in the literature. The aim of this study is to quantify patient and health-system delays and to identify their associated factors.
The study of 266 patients was based on public source data from the World Health Organization (WHO) (January 2, 2017–May 16, 2018). The diagnostic delays, patient delays, and health-system delays were calculated and modelled using a Poisson regression analysis.
In 266 MERS-CoV patients reported during the study period, the median diagnostic delays, patient delays, and health-system delays were 5 days (interquartile [IQR] range: 3–8 days), 4 days (IQR range: 2–7 days), and 2 days (IQR range: 1–2 days), respectively. Both patient delay (r = 0.894, P = 0.001) and health-system delay (r = 0.163, P = 0.025) were positively correlated with diagnostic delay. Older age was associated with longer health-system delay (adjusted relative ratios (aRR), 1.011; 95% confidence intervals (CI), 1.004–1.017). Diagnostic delay (aRR, 1.137; 95% CI, 1.006–1.285) and health-system delays (aRR, 1.217; 95% CI, 1.003–1.476) were significantly longer in patients who died.
Delays in MERS-CoV diagnosis exist and may be attributable to patient delay and health-system delay as both were significantly correlated with longer diagnosis delay. Early MERS-CoV diagnosis may require more sensitive risk assessment tools to reduce avoidable delays, specifically those related to patients and health system.
Url:
DOI: 10.1016/j.jiph.2019.04.002
PubMed: 31006635
PubMed Central: 7102677
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Ahmed</name><affiliation wicri:level="1"><nlm:aff id="aff0005">College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh</wicri:regionArea><wicri:noRegion>Riyadh</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff0010">King Abdullah International Medical Research Center, Riyadh, Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>King Abdullah International Medical Research Center, Riyadh</wicri:regionArea><wicri:noRegion>Riyadh</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff0015">Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Ministry of National Guard-Health Affairs, Riyadh</wicri:regionArea><wicri:noRegion>Riyadh</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">31006635</idno><idno type="pmc">7102677</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102677</idno><idno type="RBID">PMC:7102677</idno><idno type="doi">10.1016/j.jiph.2019.04.002</idno><date when="2019">2019</date><idno type="wicri:Area/Pmc/Corpus">000E49</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000E49</idno><idno type="wicri:Area/Pmc/Curation">000E49</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000E49</idno><idno type="wicri:Area/Pmc/Checkpoint">000341</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000341</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Diagnostic delays in Middle East respiratory syndrome coronavirus patients and health systems</title><author><name sortKey="Ahmed, Anwar E" sort="Ahmed, Anwar E" uniqKey="Ahmed A" first="Anwar E." last="Ahmed">Anwar E. Ahmed</name><affiliation wicri:level="1"><nlm:aff id="aff0005">College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh</wicri:regionArea><wicri:noRegion>Riyadh</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff0010">King Abdullah International Medical Research Center, Riyadh, Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>King Abdullah International Medical Research Center, Riyadh</wicri:regionArea><wicri:noRegion>Riyadh</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff0015">Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Ministry of National Guard-Health Affairs, Riyadh</wicri:regionArea><wicri:noRegion>Riyadh</wicri:noRegion></affiliation></author></analytic><series><title level="j">Journal of Infection and Public Health</title><idno type="ISSN">1876-0341</idno><idno type="eISSN">1876-035X</idno><imprint><date when="2019">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Although Middle East respiratory syndrome coronavirus (MERS-CoV) diagnostic delays remain a major challenge in health systems, the source of delays has not been recognized in the literature. The aim of this study is to quantify patient and health-system delays and to identify their associated factors.</p></sec><sec><title>Methods</title><p>The study of 266 patients was based on public source data from the World Health Organization (WHO) (January 2, 2017–May 16, 2018). The diagnostic delays, patient delays, and health-system delays were calculated and modelled using a Poisson regression analysis.</p></sec><sec><title>Results</title><p>In 266 MERS-CoV patients reported during the study period, the median diagnostic delays, patient delays, and health-system delays were 5 days (interquartile [IQR] range: 3–8 days), 4 days (IQR range: 2–7 days), and 2 days (IQR range: 1–2 days), respectively. Both patient delay (r = 0.894, P = 0.001) and health-system delay (r = 0.163, P = 0.025) were positively correlated with diagnostic delay. Older age was associated with longer health-system delay (adjusted relative ratios (aRR), 1.011; 95% confidence intervals (CI), 1.004–1.017). Diagnostic delay (aRR, 1.137; 95% CI, 1.006–1.285) and health-system delays (aRR, 1.217; 95% CI, 1.003–1.476) were significantly longer in patients who died.</p></sec><sec><title>Conclusion</title><p>Delays in MERS-CoV diagnosis exist and may be attributable to patient delay and health-system delay as both were significantly correlated with longer diagnosis delay. Early MERS-CoV diagnosis may require more sensitive risk assessment tools to reduce avoidable delays, specifically those related to patients and health system.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Memish, Z A" uniqKey="Memish Z">Z.A. Memish</name></author><author><name sortKey="Cotten, M" uniqKey="Cotten M">M. Cotten</name></author><author><name sortKey="Watson, S J" uniqKey="Watson S">S.J. Watson</name></author><author><name sortKey="Kellam, P" uniqKey="Kellam P">P. Kellam</name></author><author><name sortKey="Zumla, A" uniqKey="Zumla A">A. Zumla</name></author><author><name sortKey="Alhakeem, R F" uniqKey="Alhakeem R">R.F. Alhakeem</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ahmed, A E" uniqKey="Ahmed A">A.E. Ahmed</name></author><author><name sortKey="Alshukairi, A N" uniqKey="Alshukairi A">A.N. Alshukairi</name></author><author><name sortKey="Al Jahdali, H" uniqKey="Al Jahdali H">H. Al-Jahdali</name></author><author><name sortKey="Alaqeel, M" uniqKey="Alaqeel M">M. Alaqeel</name></author><author><name sortKey="Siddiq, S S" uniqKey="Siddiq S">S.S. Siddiq</name></author><author><name sortKey="Alsaab, H A" uniqKey="Alsaab H">H.A. Alsaab</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ahmed, A E" uniqKey="Ahmed A">A.E. Ahmed</name></author><author><name sortKey="Al Jahdali, H" uniqKey="Al Jahdali H">H. Al-Jahdali</name></author><author><name sortKey="Alshukairi, A N" uniqKey="Alshukairi A">A.N. Alshukairi</name></author><author><name sortKey="Alaqeel, M" uniqKey="Alaqeel M">M. Alaqeel</name></author><author><name sortKey="Siddiq, S S" uniqKey="Siddiq S">S.S. Siddiq</name></author><author><name sortKey="Alsaab, H" uniqKey="Alsaab H">H. Alsaab</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ahmed, A E" uniqKey="Ahmed A">A.E. Ahmed</name></author><author><name sortKey="Al Jahdali, H" uniqKey="Al Jahdali H">H. Al-Jahdali</name></author><author><name sortKey="Alaqeel, M" uniqKey="Alaqeel M">M. Alaqeel</name></author><author><name sortKey="Siddiq, S S" uniqKey="Siddiq S">S.S. Siddiq</name></author><author><name sortKey="Alsaab, H A" uniqKey="Alsaab H">H.A. Alsaab</name></author><author><name sortKey="Sakr, E A" uniqKey="Sakr E">E.A. Sakr</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ahmed, A E" uniqKey="Ahmed A">A.E. Ahmed</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Park, H Y" uniqKey="Park H">H.Y. Park</name></author><author><name sortKey="Lee, E J" uniqKey="Lee E">E.J. Lee</name></author><author><name sortKey="Ryu, Y A" uniqKey="Ryu Y">Y.A. Ryu</name></author><author><name sortKey="Kim, Y" uniqKey="Kim Y">Y. Kim</name></author><author><name sortKey="Kim, H" uniqKey="Kim H">H. Kim</name></author><author><name sortKey="Lee, H" uniqKey="Lee H">H. Lee</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ahmed, A E" uniqKey="Ahmed A">A.E. Ahmed</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ahmed, A E" uniqKey="Ahmed A">A.E. Ahmed</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bawazir, A" uniqKey="Bawazir A">A. Bawazir</name></author><author><name sortKey="Al Mazroo, E" uniqKey="Al Mazroo E">E. Al-Mazroo</name></author><author><name sortKey="Jradi, H" uniqKey="Jradi H">H. Jradi</name></author><author><name sortKey="Ahmed, A" uniqKey="Ahmed A">A. Ahmed</name></author><author><name sortKey="Badri, M" uniqKey="Badri M">M. Badri</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Al Mohaissen, M" uniqKey="Al Mohaissen M">M. Al Mohaissen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Alsahafi, A J" uniqKey="Alsahafi A">A.J. Alsahafi</name></author><author><name sortKey="Cheng, A C" uniqKey="Cheng A">A.C. Cheng</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Al Ghamdi, M" uniqKey="Al Ghamdi M">M. Al Ghamdi</name></author><author><name sortKey="Alghamdi, K M" uniqKey="Alghamdi K">K.M. Alghamdi</name></author><author><name sortKey="Ghandoora, Y" uniqKey="Ghandoora Y">Y. Ghandoora</name></author><author><name sortKey="Alzahrani, A" uniqKey="Alzahrani A">A. Alzahrani</name></author><author><name sortKey="Salah, F" uniqKey="Salah F">F. Salah</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Omrani, A S" uniqKey="Omrani A">A.S. Omrani</name></author><author><name sortKey="Shalhoub, S" uniqKey="Shalhoub S">S. Shalhoub</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Infect Public Health</journal-id><journal-id journal-id-type="iso-abbrev">J Infect Public Health</journal-id><journal-title-group><journal-title>Journal of Infection and Public Health</journal-title></journal-title-group><issn pub-type="ppub">1876-0341</issn><issn pub-type="epub">1876-035X</issn><publisher><publisher-name>Elsevier</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">31006635</article-id><article-id pub-id-type="pmc">7102677</article-id><article-id pub-id-type="publisher-id">S1876-0341(19)30135-2</article-id><article-id pub-id-type="doi">10.1016/j.jiph.2019.04.002</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Diagnostic delays in Middle East respiratory syndrome coronavirus patients and health systems</article-title></title-group><contrib-group><contrib contrib-type="author" id="aut0005"><name><surname>Ahmed</surname><given-names>Anwar E.</given-names></name><email>ahmeda5@vcu.edu</email><xref rid="aff0005" ref-type="aff">a</xref><xref rid="aff0010" ref-type="aff">b</xref><xref rid="aff0015" ref-type="aff">c</xref><xref rid="cor0005" ref-type="corresp">⁎</xref></contrib></contrib-group><aff id="aff0005"><label>a</label>College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia</aff><aff id="aff0010"><label>b</label>King Abdullah International Medical Research Center, Riyadh, Saudi Arabia</aff><aff id="aff0015"><label>c</label>Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia</aff><author-notes><corresp id="cor0005"><label>⁎</label>Correspondence to: College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, MC 2350, P.O. Box 22490, Riyadh, 11426, Saudi Arabia. <email>ahmeda5@vcu.edu</email></corresp></author-notes><pub-date pub-type="pmc-release"><day>18</day><month>4</month><year>2019</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="ppub"><season>Nov-Dec</season><year>2019</year></pub-date><pub-date pub-type="epub"><day>18</day><month>4</month><year>2019</year></pub-date><volume>12</volume><issue>6</issue><fpage>767</fpage><lpage>771</lpage><history><date date-type="received"><day>14</day><month>12</month><year>2018</year></date><date date-type="rev-recd"><day>25</day><month>2</month><year>2019</year></date><date date-type="accepted"><day>1</day><month>4</month><year>2019</year></date></history><permissions><copyright-statement>© 2019 The Author</copyright-statement><copyright-year>2019</copyright-year><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions><abstract id="abs0005"><sec><title>Background</title><p>Although Middle East respiratory syndrome coronavirus (MERS-CoV) diagnostic delays remain a major challenge in health systems, the source of delays has not been recognized in the literature. The aim of this study is to quantify patient and health-system delays and to identify their associated factors.</p></sec><sec><title>Methods</title><p>The study of 266 patients was based on public source data from the World Health Organization (WHO) (January 2, 2017–May 16, 2018). The diagnostic delays, patient delays, and health-system delays were calculated and modelled using a Poisson regression analysis.</p></sec><sec><title>Results</title><p>In 266 MERS-CoV patients reported during the study period, the median diagnostic delays, patient delays, and health-system delays were 5 days (interquartile [IQR] range: 3–8 days), 4 days (IQR range: 2–7 days), and 2 days (IQR range: 1–2 days), respectively. Both patient delay (r = 0.894, P = 0.001) and health-system delay (r = 0.163, P = 0.025) were positively correlated with diagnostic delay. Older age was associated with longer health-system delay (adjusted relative ratios (aRR), 1.011; 95% confidence intervals (CI), 1.004–1.017). Diagnostic delay (aRR, 1.137; 95% CI, 1.006–1.285) and health-system delays (aRR, 1.217; 95% CI, 1.003–1.476) were significantly longer in patients who died.</p></sec><sec><title>Conclusion</title><p>Delays in MERS-CoV diagnosis exist and may be attributable to patient delay and health-system delay as both were significantly correlated with longer diagnosis delay. Early MERS-CoV diagnosis may require more sensitive risk assessment tools to reduce avoidable delays, specifically those related to patients and health system.</p></sec></abstract><kwd-group id="kwd0005"><title>Abbreviations</title><kwd>MERS-CoV, Middle East respiratory syndrome coronavirus</kwd><kwd>WHO, World Health Organization</kwd><kwd>IQR, interquartile</kwd><kwd>RR, relative ratios</kwd><kwd>aRR, adjusted relative ratios</kwd><kwd>CI, confidence intervals</kwd></kwd-group><kwd-group id="kwd0010"><title>Keywords</title><kwd>Diagnostic delay</kwd><kwd>Patient delay</kwd><kwd>Health-system delay</kwd><kwd>MERS-CoV</kwd><kwd>Coronavirus</kwd><kwd>Saudi Arabia</kwd></kwd-group></article-meta></front></pmc><affiliations><list><country><li>Arabie saoudite</li></country></list><tree><country name="Arabie saoudite"><noRegion><name sortKey="Ahmed, Anwar E" sort="Ahmed, Anwar E" uniqKey="Ahmed A" first="Anwar E." last="Ahmed">Anwar E. Ahmed</name></noRegion><name sortKey="Ahmed, Anwar E" sort="Ahmed, Anwar E" uniqKey="Ahmed A" first="Anwar E." last="Ahmed">Anwar E. Ahmed</name><name sortKey="Ahmed, Anwar E" sort="Ahmed, Anwar E" uniqKey="Ahmed A" first="Anwar E." last="Ahmed">Anwar E. Ahmed</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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