Wang Tzong-Luen, Jang Tsrang-Neng, Huang Chien-Hsien, Kao Shang-Jyh, Lin Chor-Ming, Lee Fang-Niarn, Liu Cheng-Yao, Chong Chee-Fah, Lin Chu-Mei, Dorji Harnod, Teng Hsueh-Ju, Chang Hang
Department of Emergency Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Ann Emerg Med. 2004 Jan;43(1):17-22. doi: 10.1016/j.annemergmed.2003.08.002.
In the absence of reliable rapid confirmatory tests during severe acute respiratory syndrome (SARS) endemics, we designed a 2-phase cohort study to establish a scoring system for SARS and to evaluate whether it could improve the sensitivity and specificity of the World Health Organization (WHO) criteria.
According to the clinical characteristics and initial laboratory findings of 175 suspected cases defined by the WHO criteria (20 confirmed as cases of SARS) in 3 university teaching hospitals in Taipei between March 1 and April 20, 2003, the scoring system for SARS was designed by multivariate analysis and stepwise logistic regression as the simple arithmetic sum of point values assigned to 7 parameters. We thereafter applied the scoring system for SARS to the consecutive 232 patients (the validation group) who met the WHO criteria of suspected cases from April 21 to May 22, 2003. Final diagnosis of SARS was determined by the results of real-time polymerase chain reaction and paired serum.
The scoring system for SARS was defined as radiographic findings of multilobar or bilateral infiltrates (3 points), sputum monocyte predominance (3 points), lymphocytopenia (2 points), history of exposure (1 point), lactate dehydrogenase more than 450 U/L (1 point), C-reactive protein more than 5.0 mg/dL (1 point), and activated partial prothrombin time more than 40 seconds (1 point). Of the validation group, 60 patients (group A) were confirmed as having cases of SARS, and the other 172 (group B) patients tested negative for SARS. The total points of the scoring system for SARS at initial presentation were significantly higher in the SARS group (median 9; range 6 to 11) than in the non-SARS group (median 4; range 3 to 7; P<.001). At the cutoff value of 6 points, the sensitivity and specificity of the scoring system for SARS in diagnosing SARS were 100% and 93%, respectively. The positive and negative predictive values of the scoring system for SARS were 83% and 100%, respectively.
The scoring system for SARS can provide a rapid and reliable clinical decision to help emergency physicians detect cases of SARS more accurately in the endemic area.
在严重急性呼吸综合征（SARS）流行期间缺乏可靠的快速确诊检测方法的情况下，我们设计了一项两阶段队列研究，以建立SARS评分系统，并评估其是否能提高世界卫生组织（WHO）标准的敏感性和特异性。
根据2003年3月1日至4月20日台北市3所大学教学医院中符合WHO标准的175例疑似病例（20例确诊为SARS病例）的临床特征和初始实验室检查结果，通过多变量分析和逐步逻辑回归设计SARS评分系统，该系统为分配给7个参数的分值的简单算术和。此后，我们将SARS评分系统应用于2003年4月21日至5月22日符合WHO疑似病例标准的连续232例患者（验证组）。SARS的最终诊断由实时聚合酶链反应结果和配对血清确定。
SARS评分系统定义为多叶或双侧浸润的影像学表现（3分）、痰液单核细胞占优势（3分）、淋巴细胞减少（2分）、接触史（1分）、乳酸脱氢酶超过450 U/L（1分）、C反应蛋白超过5.0 mg/dL（1分）以及活化部分凝血活酶时间超过40秒（1分）。在验证组中，60例患者（A组）确诊为SARS病例，其他172例（B组）患者SARS检测呈阴性。SARS组初次就诊时SARS评分系统的总分（中位数9分；范围6至11分）显著高于非SARS组（中位数4分；范围3至7分；P<0.001）。在6分的临界值时，SARS评分系统诊断SARS的敏感性和特异性分别为100%和93%。SARS评分系统的阳性和阴性预测值分别为83%和100%。
SARS评分系统可提供快速可靠的临床决策，帮助急诊医生在流行地区更准确地检测SARS病例。
