The Ottawa Hospital, Ottawa, Ontario K1H 8L6.
Can Respir J. 2013 May-Jun;20(3):e55-9. doi: 10.1155/2013/762140.
Following the severe acute respiratory syndrome outbreak in 2003, hospitals have been mandated to use infection screening questionnaires to determine which patients have infectious respiratory illness and, therefore, require isolation precautions. Despite widespread use of symptom-based screening tools in Ontario, there are no data supporting the accuracy of these screening tools in hospitalized patients.
To measure the performance characteristics of infection screening tools used during the H1N1 influenza season.
The present retrospective cohort study was conducted at The Ottawa Hospital (Ottawa, Ontario) between October and December, 2009. Consecutive inpatients admitted from the emergency department were included if they were ≥18 years of age, underwent a screening tool assessment at presentation and had a most responsible diagnosis that was cardiac, respiratory or infectious. The gold-standard outcome was laboratory diagnosis of influenza.
The prevalence of laboratory-confirmed influenza was 23.5%. The sensitivity and specificity of the febrile respiratory illness screening tool were 74.5% (95% CI 60.5% to 84.8%) and 32.7% (95% CI 25.8% to 40.5%), respectively. The sensitivity and specificity of the influenza-like illness screening tool were 75.6% (95% CI 61.3% to 85.8%) and 46.3% (95% CI 38.2% to 54.7%), respectively.
The febrile respiratory illness screening tool missed 26% of active influenza cases, while 67% of noninfluenza patients were unnecessarily placed under respiratory isolation. Results of the present study suggest that infection-control practitioners should re-evaluate their strategy of screening patients at admission for contagious respiratory illness using symptom- and sign-based tests. Future efforts should focus on the derivation and validation of clinical decision rules that combine clinical features with laboratory tests.
2003 年严重急性呼吸综合征爆发后，医院被强制要求使用感染筛查问卷来确定哪些患者患有传染性呼吸道疾病，因此需要采取隔离预防措施。尽管安大略省广泛使用基于症状的筛查工具，但没有数据支持这些筛查工具在住院患者中的准确性。
测量甲型 H1N1 流感季节使用的感染筛查工具的性能特征。
本回顾性队列研究于 2009 年 10 月至 12 月在安大略省渥太华医院进行。连续从急诊室入院的年龄≥18 岁的患者，如果他们在就诊时接受了筛查工具评估，并且主要诊断为心脏、呼吸或感染性疾病，则纳入本研究。金标准结局是流感的实验室诊断。
实验室确诊流感的患病率为 23.5%。发热性呼吸道疾病筛查工具的敏感性和特异性分别为 74.5%（95%CI 60.5%至 84.8%）和 32.7%（95%CI 25.8%至 40.5%）。流感样疾病筛查工具的敏感性和特异性分别为 75.6%（95%CI 61.3%至 85.8%）和 46.3%（95%CI 38.2%至 54.7%）。
发热性呼吸道疾病筛查工具漏诊了 26%的活动性流感病例，而 67%的非流感患者被不必要地进行了呼吸道隔离。本研究结果表明，感染控制从业者应重新评估他们在入院时使用基于症状和体征的测试筛查传染性呼吸道疾病患者的策略。未来的努力应集中在开发和验证结合临床特征和实验室检测的临床决策规则上。
