社区传染病发生情况监测：急诊科症状表现分析

Surveillance of infectious disease occurrences in the community: an analysis of symptom presentation in the emergency department.

作者信息

Suyama Joe, Sztajnkrycer Matthew, Lindsell Christopher, Otten Edward J, Daniels Judith M, Kressel Amy B

机构信息

Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA.

出版信息

Acad Emerg Med. 2003 Jul;10(7):753-63. doi: 10.1111/j.1553-2712.2003.tb00070.x.

DOI:10.1111/j.1553-2712.2003.tb00070.x

PMID:12837650

Abstract

OBJECTIVES

To determine the effectiveness of a simulated emergency department (ED)-based surveillance system to detect infectious disease (ID) occurrences in the community.

METHODS

Medical records of patients presenting to an urban ED between January 1, 1999, and December 31, 2000, were retrospectively reviewed for ICD-9 codes related to ID symptomatology. ICD-9 codes, categorized into viral, gastrointestinal, skin, fever, central nervous system (CNS), or pulmonary symptom clusters, were correlated with reportable infectious diseases identified by the local health department (HD). These reportable infectious diseases are designated class A diseases (CADs) by the Ohio Department of Health. Cross-correlation functions (CCFs) tested the temporal relationship between ED symptom presentation and HD identification of CADs. The 95% confidence interval for lack of trend correlation was 0.0 +/- 0.074; thus CCFs > 0.074 were considered significant for trend correlation. Further cross-correlation analysis was performed after chronic and non-community-acquirable infectious diseases were removed from the HD database as a model for bioterrorism surveillance.

RESULTS

Fifteen thousand five hundred sixty-nine ED patients and 6,489 HD patients were identified. Six thousand two hundred eight occurrences of true CADs were identified. Only 87 (1.33%) HD cases were processed on weekends. During the study period, increased ED symptom presentation preceded increased HD identification of respective CADs by 24 hours for all symptom clusters combined (CCF = 0.112), gastrointestinal symptoms (CCF = 0.084), pulmonary symptoms (CCF = 0.110), and CNS symptoms (CCF = 0.125). The bioterrorism surveillance model revealed increased ED symptom presentation continued to precede increased HD identification of the respective CADs by 24 hours for all symptom clusters combined (CCF = 0.080), pulmonary symptoms (CCF = 0.100), and CNS symptoms (CCF = 0.120).

CONCLUSIONS

Surveillance of ED symptom presentation has the potential to identify clinically important ID occurrences in the community 24 hours prior to HD identification. Lack of weekend HD data collection suggests that the ED is a more appropriate setting for real-time ID surveillance.

摘要

目的

确定基于模拟急诊科（ED）的监测系统在检测社区传染病（ID）发病情况方面的有效性。

方法

回顾性审查1999年1月1日至2000年12月31日期间到城市急诊科就诊患者的病历，以查找与ID症状学相关的国际疾病分类第九版（ICD - 9）编码。ICD - 9编码分为病毒、胃肠道、皮肤、发热、中枢神经系统（CNS）或肺部症状群，并与当地卫生部门（HD）确定的应报告传染病相关联。这些应报告传染病被俄亥俄州卫生部指定为A类疾病（CADs）。互相关函数（CCF）测试了急诊科症状表现与HD对CADs的识别之间的时间关系。缺乏趋势相关性的95%置信区间为0.0 +/- 0.074；因此，CCF > 0.074被认为趋势相关性显著。在从HD数据库中去除慢性和非社区获得性传染病作为生物恐怖主义监测模型后，进行了进一步的互相关分析。

结果

确定了15569例急诊科患者和6489例HD患者。确定了6208例真正的CADs病例。仅87例（1.33%）HD病例在周末得到处理。在研究期间，对于所有症状群组合（CCF = 0.112）、胃肠道症状（CCF = 0.084）、肺部症状（CCF = 0.110）和CNS症状（CCF = 0.125），急诊科症状表现增加先于HD对相应CADs的识别增加24小时。生物恐怖主义监测模型显示，对于所有症状群组合（CCF = 0.080）、肺部症状（CCF = 0.100）和CNS症状（CCF = 0.120），急诊科症状表现增加继续先于HD对相应CADs的识别增加24小时。