Phuong Hoang L, de Vries Peter J, Nagelkerke Nico, Giao Phan T, Hung Le Q, Binh Tran Q, Nga Tran T Thanh, Nam Nguyen V, Kager Piet A
Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, The Netherlands.
Trop Med Int Health. 2006 Jun;11(6):869-79. doi: 10.1111/j.1365-3156.2006.01636.x.
To describe the characteristics of patients consulting commune primary healthcare posts for acute undifferentiated fever not being malaria (AUF), and to explore the diagnostic and therapeutic responses of the healthcare workers.
All patients presenting with AUF at 12 commune health posts and one clinic at the provincial malaria station, Binh Thuan, a dengue endemic province in southern Vietnam, were included. Record forms were used to fill in patient and diseases characteristics, pre-referral treatment, signs and symptoms, provisional diagnosis and installed treatment, referral and final outcome.
Two thousand ninety-six patients were included from April 2001 to March 2002. The median delay to attend the health posts was, 0.87 day for > 5, 1.15 days for children aged 5-15 years and 1.41 days for adults (P < 0.001). Sixty-five per cent of patients took some measures before consulting the health post, of whom 82% applied self-medication and 69% took antibiotics. Pre-referral medication with antibiotics increased with age (RR 1.012 per year of age; 95% CI: 1.004-1.019). The diagnostic and therapeutic response of healthcare workers was very unspecific. The tourniquet test was inappropriately used as general discriminating test, not only for detecting dengue haemorrhagic fever. Empiric antibiotic therapy was installed in 77.2% of cases.
Management of uncomplicated fever, not being malaria, at the primary healthcare level in Vietnam is non-specific, dominated by searching signs of hemorrhagic dengue and empiric antibiotic treatment. This can probably be improved by better education.
描述因急性未分化型非疟疾发热（AUF）前往社区基层医疗点就诊的患者特征，并探讨医护人员的诊断和治疗反应。
纳入越南南部登革热流行省份平顺省12个社区卫生站和省级疟疾防治站的1个诊所中所有出现AUF症状的患者。使用记录表格填写患者和疾病特征、转诊前治疗、体征和症状、初步诊断及既定治疗、转诊情况和最终结果。
2001年4月至2002年3月共纳入2096例患者。前往卫生站就诊的中位延迟时间为：5岁以上患者为0.87天，5 - 15岁儿童为1.15天，成人患者为1.41天（P < 0.001）。65%的患者在前往卫生站就诊前采取了一些措施，其中82%进行了自我用药，69%使用了抗生素。转诊前使用抗生素的比例随年龄增长而增加（年龄每增加1岁，相对危险度为1.012；95%可信区间：1.004 - 1.019）。医护人员的诊断和治疗反应非常不具特异性。束臂试验被不恰当地用作一般鉴别试验，而不仅仅用于检测登革出血热。77.2%的病例采用了经验性抗生素治疗。
越南基层医疗层面对于非疟疾的单纯发热的管理缺乏特异性，主要以寻找出血性登革热迹象和经验性抗生素治疗为主。通过更好的教育或许可以改善这种情况。
