Brito-Zerón Pilar, Nicolás-Ocejo David, Jordán Anna, Retamozo Soledad, López-Soto Alfonso, Bosch Xavier
Department of Autoimmune Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
Eur J Clin Invest. 2014 Aug;44(8):707-18. doi: 10.1111/eci.12287.
Outpatient quick diagnosis units (QDUs) have become an increasingly recognized alternative to hospitalization for the diagnosis of a number of potentially serious diseases. No study has prospectively evaluated the usefulness of QDU for the diagnosis of unexplained fever.
We prospectively assessed patients referred to QDU due to fever of uncertain nature (FUN), defined as a temperature > 38 °C during at least 1 week and no diagnosis after a previous evaluation. We also evaluated consecutive patients with FUN who were hospitalized during the same period. QDU and hospital costs were analysed by micro-costing techniques.
We evaluated 176 QDU patients and 168 controls. QDU patients were younger and required fewer investigations than controls. QDU patients had higher prevalence of viral infections (36% vs. 8%, P < 0·001) and lower prevalence of bacterial infections (6% vs. 46%, P < 0·001) and malignancies (2% vs. 14%, P < 0·001). While time-to-diagnosis of QDU patients was longer than length-of-stay of controls (25·82 vs.12·89 days, P < 0·001), 56% of QDU patients only required up to two visits. Cost per QDU patient was €644·59, while it was €4404·64 per hospitalized patient.
QDU patients with FUN were younger and had less serious diseases than controls including more viral and less bacterial infections and fewer malignancies. Mainly owing to untimely diagnostic reports, time-to-diagnosis was longer in QDU patients. Cost-savings in QDU were substantial. Using objective tools to evaluate the condition severity and general health status of FUN patients could help decide the most appropriate setting for their diagnostic study.
门诊快速诊断单元（QDUs）已成为诊断多种潜在严重疾病时越来越被认可的替代住院治疗的方式。尚无研究前瞻性评估QDUs对不明原因发热的诊断效用。
我们前瞻性评估了因性质不明的发热（FUN）而转诊至QDUs的患者，FUN定义为至少1周内体温>38°C且先前评估后未确诊。我们还评估了同期住院的连续性FUN患者。通过微观成本核算技术分析QDUs和医院成本。
我们评估了176例QDUs患者和168例对照。QDUs患者比对照更年轻，所需检查更少。QDUs患者病毒感染患病率更高（36%对8%，P<0.001），细菌感染患病率更低（6%对46%，P<0.001），恶性肿瘤患病率更低（2%对14%，P<0.001）。虽然QDUs患者的诊断时间比对照的住院时间长（25.82天对12.89天，P<0.001），但56%的QDUs患者仅需就诊至多两次。每位QDUs患者的成本为644.59欧元，而每位住院患者的成本为4404.64欧元。
患有FUN的QDUs患者比对照更年轻，疾病较轻，包括病毒感染更多、细菌感染更少和恶性肿瘤更少。主要由于诊断报告不及时，QDUs患者的诊断时间更长。QDUs节省的成本可观。使用客观工具评估FUN患者的病情严重程度和总体健康状况有助于决定其诊断研究的最合适环境。
