Centre for Epidemiology and Research, New South Wales Department of Health, 73 Miller Street, North Sydney, NSW 2059, Australia.
BMC Infect Dis. 2010 Oct 27;10:309. doi: 10.1186/1471-2334-10-309.
Meningococcal infection causes severe, rapidly progressing illness and reporting of cases is mandatory in New South Wales (NSW), Australia. The NSW Department of Health operates near real-time Emergency Department (ED) surveillance that includes capture and statistical analysis of clinical preliminary diagnoses. The system can provide alerts in response to specific diagnoses entered in the ED computer system. This study assessed whether once daily reporting of clinical diagnoses of meningococcal infection using the ED surveillance system provides an opportunity for timelier public health response for this disease.
The study involved a prospective and retrospective component. First, reporting of ED diagnoses of meningococcal infection from the ED surveillance system prospectively operated in parallel with conventional surveillance which requires direct telephone reporting of this scheduled medical condition to local public health authorities by hospitals and laboratories when a meningococcal infection diagnosis is made. Follow-up of the ED diagnoses determined whether meningococcal infection was confirmed, and the time difference between ED surveillance report and notification by conventional means. Second, cases of meningococcal infection reported by conventional surveillance during 2004 were retrospectively matched to ED visits to determine the sensitivity and positive predictive value (PPV) of ED surveillance.
During the prospective evaluation, 31 patients were diagnosed with meningococcal infection in participating EDs. Of these, 12 had confirmed meningococcal disease, resulting in a PPV of 38.7%. All confirmed cases were notified earlier to public health authorities by conventional reporting.Of 149 cases of notified meningococcal disease identified retrospectively, 130 were linked to an ED visit. The sensitivity and PPV of the ED diagnosis for meningococcal infection was 36.2% and 36.7%, respectively.
Based on prospective evaluation, it is reassuring that existing mechanisms for reporting meningococcal infection perform well and are timely. The retrospective evaluation found low sensitivity and PPV of ED diagnoses for meningococcal disease. Even if more rapid forwarding of ED meningococcal diagnoses to public health authorities were possible, the low sensitivity and PPV do not justify this. In this study, use of an ED surveillance system to augment conventional surveillance of this scheduled medical condition did not demonstrate a benefit.
脑膜炎球菌感染可导致严重、迅速进展的疾病，在澳大利亚新南威尔士州（NSW）必须报告病例。新南威尔士州卫生部实施实时急诊（ED）监测，包括对临床初步诊断的采集和统计分析。该系统可以针对 ED 计算机系统中输入的特定诊断发出警报。本研究评估了使用 ED 监测系统每天一次报告临床脑膜炎球菌感染诊断是否为该疾病提供了更及时的公共卫生响应机会。
该研究包括前瞻性和回顾性部分。首先，ED 监测系统前瞻性地报告 ED 诊断的脑膜炎球菌感染，同时常规监测需要医院和实验室在诊断脑膜炎球菌感染时直接通过电话向当地公共卫生当局报告这种规定的医疗条件。对 ED 诊断的随访确定了脑膜炎球菌感染是否得到确认，以及 ED 监测报告与常规方法通知之间的时间差异。其次，回顾性匹配常规监测报告的脑膜炎球菌感染病例与 ED 就诊，以确定 ED 监测的敏感性和阳性预测值（PPV）。
在前瞻性评估期间，参与 ED 的 31 名患者被诊断患有脑膜炎球菌感染。其中，12 例经证实患有脑膜炎球菌病，PPV 为 38.7%。所有确诊病例均通过常规报告更早地通知公共卫生当局。回顾性确定的 149 例报告的脑膜炎球菌病病例中，有 130 例与 ED 就诊相关。ED 诊断脑膜炎球菌感染的敏感性和 PPV 分别为 36.2%和 36.7%。
基于前瞻性评估，现有的脑膜炎球菌感染报告机制运行良好且及时，这令人感到欣慰。回顾性评估发现 ED 诊断脑膜炎球菌病的敏感性和 PPV 较低。即使可以更快地将 ED 脑膜炎球菌诊断转发给公共卫生当局，较低的敏感性和 PPV 也不能证明这是合理的。在本研究中，使用 ED 监测系统来扩充这种规定医疗条件的常规监测并未显示出益处。
