Toledo Ana Lucia Araujo de, Escosteguy Claudia Caminha, Medronho Roberto de Andrade, Andrade Flávia Coutinho de
Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Cad Saude Publica. 2006 May;22(5):933-40. doi: 10.1590/s0102-311x2006000500006. Epub 2006 Apr 28.
This study analyzed the reliability of the final diagnosis in the 155,242 dengue reports during the 2001-2002 epidemic in the city of Rio de Janeiro, Brazil, using the official information system on communicable diseases (SINAN). The system allows the following options for the final diagnosis: classic dengue, dengue hemorrhagic fever, discarded, inconclusive, and unknown. We built a classification routine in Epi Info to compare the final diagnosis from SINAN with Ministry of Health criteria. According to the final diagnosis, the case breakdown was: 52.4% classic dengue; 0.6% dengue hemorrhagic fever; 0.9% discarded; 46% inconclusive and unknown. The revised diagnosis showed that 78% of classic dengue, 69% of dengue hemorrhagic fever, and 21.1% of discarded cases met the classification criteria. Although the reliability of the SINAN final diagnosis was generally satisfactory (kappa = 0.681; 95%CI: 0.685-0.677), it was worse for fatal cases (kappa = 0.152; 95%CI: 0.046-0.258). Considering the epidemic's magnitude, the final diagnosis of classic dengue and dengue hemorrhagic fever was satisfactory, but the high proportion of inconclusive or unknown cases and the poor quality of information for fatal cases limit the usefulness of SINAN in this context.
本研究利用巴西里约热内卢市官方传染病信息系统(SINAN),分析了2001 - 2002年疫情期间155242份登革热报告中最终诊断的可靠性。该系统对最终诊断提供了以下选项:典型登革热、登革出血热、排除、不确定和未知。我们在Epi Info中建立了一个分类程序,以将SINAN的最终诊断与卫生部标准进行比较。根据最终诊断,病例分类如下:52.4%为典型登革热;0.6%为登革出血热;0.9%为排除;46%为不确定和未知。修订后的诊断显示,78%的典型登革热、69%的登革出血热和21.1%的排除病例符合分类标准。尽管SINAN最终诊断的可靠性总体上令人满意(kappa = 0.681;95%CI:0.685 - 0.677),但对于致命病例而言则较差(kappa = 0.152;95%CI:0.046 - 0.258)。考虑到疫情的规模,典型登革热和登革出血热的最终诊断是令人满意的,但不确定或未知病例的高比例以及致命病例信息质量较差限制了SINAN在此背景下的实用性。