Su Chan-Ping, Chiang Wen-Chu, Ma Matthew Huei-Ming, Chen Shey-Ying, Hsu Chiung-Yuan, Ko Patrick Chow-In, Tsai Kuang-Chau, Fan Chieh-Min, Shih Fuh-Yuan, Chen Shyr-Chyr, Chen Yee-Chun, Chang Shan-Chwen, Chen Wen-Jone
Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Ann Emerg Med. 2004 Jan;43(1):34-42. doi: 10.1016/j.annemergmed.2003.10.042.
In a pilot study conducted during March 14 to April 2, 2003, 2 severe acute respiratory syndrome (SARS) screening scores were developed for predicting SARS among febrile patients presenting to the emergency department (ED). The objective of this study is to validate these scoring systems with a different set of patients.
All adult patients with documented fever, measured at home or at the hospital, and presenting to the ED of National Taiwan University Hospital, a 2,400-bed tertiary care teaching hospital in northern Taiwan, were prospectively enrolled. Two previously developed SARS screening scores were applied to all patients. The final diagnosis of SARS was made by the Expert Committee of the Center for Disease Control Taiwan, Republic of China, according to the criteria of Centers for Disease Control and Prevention, Atlanta, GA.
A total of 239 adult patients, including 117 men and 122 women, were enrolled. Eighty-two patients were finally diagnosed with SARS. Compared with the SARS patients in the derivation cohort, those in the validation cohort were older (44.5+/-15.9 versus 33.9+/-15.9 years), more likely to acquire the disease locally (76.8% versus 37.5%), and more likely to have cough before or during fever. For the non-SARS patients, cases in the validation cohort presented with less cough and coryza but more diarrhea. For the 4-item symptom score, the sensitivity reached 96.3% (95% confidence interval [CI] 89.7% to 98.7%) and the specificity 51.6% (95% CI 43.8% to 59.3%). For the 6-item clinical score, the sensitivity reached 92.6% (95% CI 84.8% to 96.6%) and the specificity 71.2% (95% CI 63.6% to 77.7%). When the clinical score was applied to patients with a positive symptom score, the combined sensitivity reached 90.2% (95% CI 82.0% to 95.0%), and the combined specificity reached 80.1% (95% CI 73.2% to 85.6%).
This prospective study validated the scoring system previously developed by using a different cohort. The scoring systems could be applied to settings where mass screening of SARS is needed during future outbreaks.
在2003年3月14日至4月2日进行的一项初步研究中，开发了两种严重急性呼吸综合征（SARS）筛查评分，用于预测到急诊科（ED）就诊的发热患者中是否感染SARS。本研究的目的是用另一组患者验证这些评分系统。
前瞻性纳入所有有记录的在家或在医院测量过体温且到台湾大学附属医院急诊科就诊的成年患者，该医院是台湾北部一家拥有2400张床位的三级医疗教学医院。将之前开发的两种SARS筛查评分应用于所有患者。SARS的最终诊断由中华台北疾病控制中心专家委员会根据美国佐治亚州亚特兰大疾病控制与预防中心的标准做出。
共纳入239例成年患者，包括117例男性和122例女性。82例患者最终被诊断为SARS。与推导队列中的SARS患者相比，验证队列中的患者年龄更大（44.5±15.9岁对33.9±15.9岁），更可能在当地感染该病（76.8%对37.5%），且在发热前或发热期间更可能出现咳嗽。对于非SARS患者，验证队列中的病例咳嗽和鼻塞症状较少，但腹泻较多。对于4项症状评分，敏感性达到96.3%（95%置信区间[CI]89.7%至98.7%），特异性为51.6%（95%CI43.8%至59.3%）。对于6项临床评分，敏感性达到92.6%（95%CI84.8%至96.6%），特异性为71.2%（95%CI63.6%至77.7%）。当将临床评分应用于症状评分阳性的患者时，联合敏感性达到90.2%（95%CI82.0%至95.0%），联合特异性达到80.1%（95%CI73.2%至85.6%）。
这项前瞻性研究用不同队列验证了之前开发的评分系统。这些评分系统可应用于未来疫情爆发期间需要对SARS进行大规模筛查的情况。
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