Schull Michael J, Stukel Therese A, Vermeulen Marian J, Guttmann Astrid, Zwarenstein Merrick
Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5.
Acad Emerg Med. 2006 Nov;13(11):1228-31. doi: 10.1197/j.aem.2006.04.011. Epub 2006 Jun 28.
Current influenza pandemic models predict a surge in influenza-related hospitalizations in affected jurisdictions. One proposed strategy to increase hospital surge capacity is to restrict elective hospitalizations, yet the degree to which this measure would meet the anticipated is unknown.
To compare the reduction in hospitalizations resulting from widespread nonurgent hospital admission restrictions during the Toronto severe acute respiratory syndrome (SARS) outbreak with the expected increase in admissions resulting from an influenza pandemic in Toronto.
The authors compared the expected influenza-related hospitalizations in the first eight weeks of a mild, moderate, or severe pandemic with the actual reduction in the number of hospital admissions in Toronto, Ontario, during the first eight weeks of the SARS-related restrictions.
Influenza modeling for Toronto predicts that there will be 4,819, 8,032, or 11,245 influenza-related admissions in the first eight weeks of a mild, moderate, or severe pandemic, respectively. In the first eight weeks of SARS-related hospital admission restrictions, there were 3,654 fewer hospitalizations than expected in Toronto, representing a modest 12% decrease in the overall admission rate (a reduction of 1.40 admissions per 1,000 population). Therefore, influenza-related admissions could exceed the reduction in admissions resulting from restricted hospital utilization by 1,165 to 7,591 patient admissions, depending on pandemic severity, which corresponds to an excess of 0.44 to 2.91 influenza-related admissions per 1,000 population per eight weeks, and an increase of 4% to 25% in the overall number of admissions, when compared with nonpandemic conditions.
Pandemic modeling for Toronto suggests that influenza-related admissions would exceed the reduction in hospitalizations seen during SARS-related nonurgent hospital admission restrictions, even in a mild pandemic. Sufficient surge capacity in a pandemic will likely require the implementation of other measures, including possibly stricter implementation of hospital utilization restrictions.
当前的流感大流行模型预测，受影响地区与流感相关的住院人数将激增。一种提高医院应急能力的提议策略是限制择期住院，但这一措施能满足预期需求的程度尚不清楚。
比较多伦多严重急性呼吸综合征（SARS）疫情期间广泛实施非紧急住院限制导致的住院人数减少情况，与多伦多流感大流行预计导致的住院人数增加情况。
作者将轻度、中度或重度大流行前八周预计的与流感相关的住院人数，与安大略省多伦多市在SARS相关限制措施实施的前八周实际住院人数的减少情况进行了比较。
多伦多的流感模型预测，在轻度、中度或重度大流行的前八周，与流感相关的住院人数分别为4819例、8032例或11245例。在与SARS相关的住院限制措施实施的前八周，多伦多的住院人数比预期少3654例，总体住院率适度下降了12%（每1000人口减少1.40例住院）。因此，根据大流行的严重程度，与流感相关的住院人数可能比因限制医院使用而导致的住院人数减少多出1165至7591例，相当于每1000人口每八周多出0.44至2.91例与流感相关的住院人数，与非大流行情况相比，住院总人数增加了4%至25%。
多伦多的大流行模型表明，即使是轻度大流行，与流感相关的住院人数也将超过SARS相关非紧急住院限制期间的住院人数减少量。大流行期间足够的应急能力可能需要实施其他措施，包括可能更严格地实施医院使用限制。
