Greenko Jane, Mostashari Farzad, Fine Annie, Layton Marci
Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, New York, NY 10013, USA.
J Urban Health. 2003 Jun;80(2 Suppl 1):i50-6. doi: 10.1007/pl00022315.
Since 1998, the New York City Department of Health has used New York City Emergency Medical Services (EMS) ambulance dispatch data to monitor for a communitywide rise in influenzalike illness (ILI) as an early detection system for bioterrorism. A clinical validation study was conducted during peak influenza season at six New York City emergency departments (EDs) to compare patients with ILI brought in by ambulance with other patients to examine potential biases associated with ambulance dispatch-based surveillance. We also examined the utility of 4 EMS call types (selected from 52) for case detection of ILI. Clinical ILI was defined as fever (temperature higher than 100 degrees F) on history or exam, along with either cough or sore throat. Of the 2,294 ED visits reviewed, 522 patients (23%) met the case definition for ILI, 64 (12%) of whom arrived by ambulance. Patients with ILI brought in by ambulance were older, complained of more severe symptoms, and were more likely to undergo diagnostic testing, be diagnosed with pneumonia, and be admitted to the hospital than patients who arrived by other means. The median duration of symptoms prior to presenting to the ED, however, was the same for both groups (48 hours). The selected call types had a sensitivity of 58% for clinical ILI, and a predictive value positive of 22%. Individuals with symptoms consistent with the prodrome of inhalational anthrax were likely to utilize the EMS system and usually did so early in the course of illness. While EMS-based surveillance is more sensitive for severe illness and for illness affecting older individuals, there is not necessarily a loss of timeliness associated with EMS-based (versus ED-based) surveillance.
自1998年以来,纽约市卫生部门利用纽约市紧急医疗服务(EMS)救护车调度数据,监测社区范围内流感样疾病(ILI)的增加情况,以此作为生物恐怖主义的早期检测系统。在纽约市六个急诊科流感高发季节期间进行了一项临床验证研究,比较救护车送来的ILI患者与其他患者,以检查基于救护车调度监测的潜在偏差。我们还研究了4种EMS呼叫类型(从52种中选出)在ILI病例检测中的效用。临床ILI定义为病史或检查中有发热(体温高于100华氏度),并伴有咳嗽或喉咙痛。在审查的2294次急诊就诊中,522名患者(23%)符合ILI病例定义,其中64名(12%)是乘坐救护车前来的。与通过其他方式前来的患者相比,乘坐救护车送来的ILI患者年龄更大,症状更严重,更有可能接受诊断测试、被诊断为肺炎并住院。然而,两组患者在前往急诊科之前症状的中位持续时间相同(48小时)。所选的呼叫类型对临床ILI的敏感性为58%,阳性预测值为22%。有与吸入性炭疽前驱症状相符症状的个体可能会使用EMS系统,而且通常在病程早期就会这样做。虽然基于EMS的监测对严重疾病和影响老年人的疾病更敏感,但基于EMS(与基于急诊科)的监测不一定会失去及时性。