Evaluation of WHO criteria for identifying patients with severe acute respiratory syndrome out of hospital: prospective observational study
Identifieur interne : 006280 ( Main/Exploration ); précédent : 006279; suivant : 006281Evaluation of WHO criteria for identifying patients with severe acute respiratory syndrome out of hospital: prospective observational study
Auteurs : Timothy H. Rainer [République populaire de Chine] ; Peter A. Cameron [République populaire de Chine] ; Devilliers Smit [République populaire de Chine] ; Kim L. Ong [République populaire de Chine] ; Alex Ng Wing Hung [République populaire de Chine] ; David Chan Po Nin [République populaire de Chine] ; Anil T. Ahuja [République populaire de Chine] ; Louis Chan Yik Si [République populaire de Chine] ; Joseph J Y. Sung [République populaire de Chine]Source :
- BMJ [ 0959-8138 ] ; 2003-06-21.
English descriptors
- Teeft :
- Abdominal pain, Abstract objectives, Administrative region, Adverse outcome, Breathing difficulty, Case definitions, Chan, Chest radiographs, Chest radiography, Chinese university, Clinic, Clinical features, Clinical symptoms, Confidence interval, Coronavirus, Diastolic blood pressure, Early stages, Emergency department, Emergency medicine, Exact test, First attendance, First presentation, Frontal chest radiograph, Ground glass opacification, Guideline, Haematological findings, Health advice, Healthcare workers, High fever, High resolution, Hong kong, Hospital staff, Hygiene advice, Lancet peiris, Neck pain, Normal chest radiographs, Novel coronavirus, Overall accuracy, Persistent fever, Pneumonia, Pneumonic change, Posterior segments, Probable cases, Radiograph, Radiography, Radiological, Radiological evidence, Respiratory rate, Respiratory symptoms, Respiratory syndrome, Runny nose, Sars, Sars patients, Sars screening clinic, Screening clinic, Screening patients, Secondary infections, Sore throat, Statistical analysis, Symptom, Syndrome, Systemic symptoms, Tract symptoms, Wales hospital, World health organization.
Abstract
Objectives To determine the clinical and radiological features of severe acute respiratory syndrome (SARS) and to evaluate the accuracy of the World Health Organization's guidelines on defining cases of SARS. Design Prospective observational study. Setting A newly set up SARS screening clinic in the emergency department of a university hospital in Hong Kong's New Territories. Participants 556 hospital staff, patients, and relatives who attended the screening clinic and who had had contact with someone with SARS. Main outcome measure Number of confirmed cases of SARS. Results Of the 556 people, 141 were admitted to hospital, and 97 had confirmed SARS. Fever, chills, malaise, myalgia, rigor, loss of appetite, vomiting, diarrhoea, and neck pain but not respiratory tract symptoms were significantly more common among the 97 patients than among the other patients. The overall accuracy of the WHO guidelines for identifying suspected SARS was 83% and their negative predictive value was 86% (95% confidence interval 83% to 89%). They had a sensitivity of 26% (17% to 36%) and a specificity of 96% (93% to 97%). Conclusions Current WHO guidelines for diagnosing suspected SARS may not be sufficiently sensitive in assessing patients before admission to hospital. Daily follow up, evaluation of non-respiratory, systemic symptoms, and chest radiography would be better screening tools.
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DOI: 10.1136/bmj.326.7403.1354
Affiliations:
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Sung</name><affiliation wicri:level="4"><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong</wicri:regionArea><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author></analytic><monogr></monogr><series><title level="j">BMJ</title><title level="j" type="abbrev">BMJ</title><idno type="ISSN">0959-8138</idno><idno type="eISSN">1468-5833</idno><imprint><publisher>British Medical Journal Publishing Group</publisher><date type="published" when="2003-06-21">2003-06-21</date><biblScope unit="volume">326</biblScope><biblScope unit="issue">7403</biblScope><biblScope unit="page" from="1354">1354</biblScope></imprint><idno type="ISSN">0959-8138</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0959-8138</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="Teeft" xml:lang="en"><term>Abdominal pain</term><term>Abstract objectives</term><term>Administrative region</term><term>Adverse outcome</term><term>Breathing difficulty</term><term>Case definitions</term><term>Chan</term><term>Chest radiographs</term><term>Chest radiography</term><term>Chinese university</term><term>Clinic</term><term>Clinical features</term><term>Clinical symptoms</term><term>Confidence interval</term><term>Coronavirus</term><term>Diastolic blood pressure</term><term>Early stages</term><term>Emergency department</term><term>Emergency medicine</term><term>Exact test</term><term>First attendance</term><term>First presentation</term><term>Frontal chest radiograph</term><term>Ground glass opacification</term><term>Guideline</term><term>Haematological findings</term><term>Health advice</term><term>Healthcare workers</term><term>High fever</term><term>High resolution</term><term>Hong kong</term><term>Hospital staff</term><term>Hygiene advice</term><term>Lancet peiris</term><term>Neck pain</term><term>Normal chest radiographs</term><term>Novel coronavirus</term><term>Overall accuracy</term><term>Persistent fever</term><term>Pneumonia</term><term>Pneumonic change</term><term>Posterior segments</term><term>Probable cases</term><term>Radiograph</term><term>Radiography</term><term>Radiological</term><term>Radiological evidence</term><term>Respiratory rate</term><term>Respiratory symptoms</term><term>Respiratory syndrome</term><term>Runny nose</term><term>Sars</term><term>Sars patients</term><term>Sars screening clinic</term><term>Screening clinic</term><term>Screening patients</term><term>Secondary infections</term><term>Sore throat</term><term>Statistical analysis</term><term>Symptom</term><term>Syndrome</term><term>Systemic symptoms</term><term>Tract symptoms</term><term>Wales hospital</term><term>World health organization</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objectives To determine the clinical and radiological features of severe acute respiratory syndrome (SARS) and to evaluate the accuracy of the World Health Organization's guidelines on defining cases of SARS. Design Prospective observational study. Setting A newly set up SARS screening clinic in the emergency department of a university hospital in Hong Kong's New Territories. Participants 556 hospital staff, patients, and relatives who attended the screening clinic and who had had contact with someone with SARS. Main outcome measure Number of confirmed cases of SARS. Results Of the 556 people, 141 were admitted to hospital, and 97 had confirmed SARS. Fever, chills, malaise, myalgia, rigor, loss of appetite, vomiting, diarrhoea, and neck pain but not respiratory tract symptoms were significantly more common among the 97 patients than among the other patients. The overall accuracy of the WHO guidelines for identifying suspected SARS was 83% and their negative predictive value was 86% (95% confidence interval 83% to 89%). They had a sensitivity of 26% (17% to 36%) and a specificity of 96% (93% to 97%). Conclusions Current WHO guidelines for diagnosing suspected SARS may not be sufficiently sensitive in assessing patients before admission to hospital. Daily follow up, evaluation of non-respiratory, systemic symptoms, and chest radiography would be better screening tools.</div></front></TEI><affiliations><list><country><li>République populaire de Chine</li></country><settlement><li>Sha Tin</li></settlement><orgName><li>Université chinoise de Hong Kong</li></orgName></list><tree><country name="République populaire de Chine"><noRegion><name sortKey="Rainer, Timothy H" sort="Rainer, Timothy H" uniqKey="Rainer T" first="Timothy H" last="Rainer">Timothy H. Rainer</name></noRegion><name sortKey="Ahuja, Anil T" sort="Ahuja, Anil T" uniqKey="Ahuja A" first="Anil T" last="Ahuja">Anil T. Ahuja</name><name sortKey="Cameron, Peter A" sort="Cameron, Peter A" uniqKey="Cameron P" first="Peter A" last="Cameron">Peter A. Cameron</name><name sortKey="Hung, Alex Ng Wing" sort="Hung, Alex Ng Wing" uniqKey="Hung A" first="Alex Ng Wing" last="Hung">Alex Ng Wing Hung</name><name sortKey="Nin, David Chan Po" sort="Nin, David Chan Po" uniqKey="Nin D" first="David Chan Po" last="Nin">David Chan Po Nin</name><name sortKey="Ong, Kim L" sort="Ong, Kim L" uniqKey="Ong K" first="Kim L" last="Ong">Kim L. Ong</name><name sortKey="Rainer, Timothy H" sort="Rainer, Timothy H" uniqKey="Rainer T" first="Timothy H" last="Rainer">Timothy H. Rainer</name><name sortKey="Si, Louis Chan Yik" sort="Si, Louis Chan Yik" uniqKey="Si L" first="Louis Chan Yik" last="Si">Louis Chan Yik Si</name><name sortKey="Smit, Devilliers" sort="Smit, Devilliers" uniqKey="Smit D" first="Devilliers" last="Smit">Devilliers Smit</name><name sortKey="Sung, Joseph J Y" sort="Sung, Joseph J Y" uniqKey="Sung J" first="Joseph J Y" last="Sung">Joseph J Y. Sung</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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