The rationale of fever surveillance to identify patients with severe acute respiratory syndrome in Taiwan
Identifieur interne : 000B38 ( Istex/Curation ); précédent : 000B37; suivant : 000B39The rationale of fever surveillance to identify patients with severe acute respiratory syndrome in Taiwan
Auteurs : L-M Wang [Taïwan] ; Y-C Chen [Taïwan] ; S-P Tung [Taïwan] ; C-Y Chen ; S-C Chang ; S-C Chiang [Taïwan] ; C-H LeeSource :
- Emergency Medicine Journal [ 1472-0205 ] ; 2006-03.
English descriptors
- KwdEn :
- Teeft :
- Best balance, Chest radiography, Clinical features, Complete blood count, Contagious disease, Coronavirus antibody, Curves analysis, Cutoff value, Disease control, Early stage, Emergency department, Emergency departments, Emergency medicine, Emergency physicians, Endemic area, Exact test, Febrile, Febrile patients, Fever screening station, Fever surveillance, Final analysis, Final diagnosis, General hospital, Hong kong, Hospital transmission, Household history, Outbreak, Possible sars, Possible sars cases, Predictive ability, Predictive indicators, Probable cases, Reflection point, Respiratory syndrome, Sars, Sars cases, Sars contact history, Sars infection, Sars outbreak, Sars patients, Screening, Screening patients, Screening station score, Screening station stage, Station score, Syndrome, Syndromic surveillance, Taiwan wang, Triage, Triage score, Triage scores, Triage stage, World health organization.
Abstract
Study objective: To establish a predictive scoring system and to determine its effectiveness for severe acute respiratory syndrome (SARS) cases confirmed by RT-PCR in patients with fever. Methods: A study was conducted of 484 consecutive patients seen in the emergency department (ED) of our tertiary care center during the SARS outbreak in Taiwan. The scoring system was divided into triage and screening station stages. Data were analysed with multivariable and logistic regression analysis. Results: Of 737 patients who presented to our ED for possible SARS from March to June 2003, we enrolled 484 patients with a temperature >38.0°C (>100.3°F) (age >18 years). Dyspnoea, diarrhoea, travel, close contact, hospital exposure, and household history were identified as predictive indicators in the triage stage. The triage score was the total of six items. With a one-point cutoff value, the sensitivity and specificity were 81.8% (18/22) and 73.6% (340/462). Leukocytosis, thrombocytopenia, lymphopenia, and CXR were identified as predictive indicators in the fever screening stage. Screening station scores (the sum of 10 items) consisted of triage scores, white blood cell count, and CXR. With a three-point cutoff value, the sensitivity and specificity were 95.5% (21/22) and 87.2% (403/462). Conclusions: Syndromic and traditional surveillance play a role in early identification of SARS in an endemic area. The SARS scoring system described is easily applicable and highly effective in screening patients during outbreaks.
Url:
DOI: 10.1136/emj.2005.027037
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<front><div type="abstract" xml:lang="en">Study objective: To establish a predictive scoring system and to determine its effectiveness for severe acute respiratory syndrome (SARS) cases confirmed by RT-PCR in patients with fever. Methods: A study was conducted of 484 consecutive patients seen in the emergency department (ED) of our tertiary care center during the SARS outbreak in Taiwan. The scoring system was divided into triage and screening station stages. Data were analysed with multivariable and logistic regression analysis. Results: Of 737 patients who presented to our ED for possible SARS from March to June 2003, we enrolled 484 patients with a temperature >38.0°C (>100.3°F) (age >18 years). Dyspnoea, diarrhoea, travel, close contact, hospital exposure, and household history were identified as predictive indicators in the triage stage. The triage score was the total of six items. With a one-point cutoff value, the sensitivity and specificity were 81.8% (18/22) and 73.6% (340/462). Leukocytosis, thrombocytopenia, lymphopenia, and CXR were identified as predictive indicators in the fever screening stage. Screening station scores (the sum of 10 items) consisted of triage scores, white blood cell count, and CXR. With a three-point cutoff value, the sensitivity and specificity were 95.5% (21/22) and 87.2% (403/462). Conclusions: Syndromic and traditional surveillance play a role in early identification of SARS in an endemic area. The SARS scoring system described is easily applicable and highly effective in screening patients during outbreaks.</div>
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