College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
J Infect Public Health. 2019 Nov-Dec;12(6):767-771. doi: 10.1016/j.jiph.2019.04.002. Epub 2019 Apr 18.
Although Middle East respiratory syndrome coronavirus (MERS-CoV) diagnostic delays remain a major challenge in health systems, the source of delays has not been recognized in the literature. The aim of this study is to quantify patient and health-system delays and to identify their associated factors.
The study of 266 patients was based on public source data from the World Health Organization (WHO) (January 2, 2017-May 16, 2018). The diagnostic delays, patient delays, and health-system delays were calculated and modelled using a Poisson regression analysis.
In 266 MERS-CoV patients reported during the study period, the median diagnostic delays, patient delays, and health-system delays were 5 days (interquartile [IQR] range: 3-8 days), 4 days (IQR range: 2-7 days), and 2 days (IQR range: 1-2 days), respectively. Both patient delay (r = 0.894, P = 0.001) and health-system delay (r = 0.163, P = 0.025) were positively correlated with diagnostic delay. Older age was associated with longer health-system delay (adjusted relative ratios (aRR), 1.011; 95% confidence intervals (CI), 1.004-1.017). Diagnostic delay (aRR, 1.137; 95% CI, 1.006-1.285) and health-system delays (aRR, 1.217; 95% CI, 1.003-1.476) were significantly longer in patients who died.
Delays in MERS-CoV diagnosis exist and may be attributable to patient delay and health-system delay as both were significantly correlated with longer diagnosis delay. Early MERS-CoV diagnosis may require more sensitive risk assessment tools to reduce avoidable delays, specifically those related to patients and health system.
尽管中东呼吸综合征冠状病毒（MERS-CoV）的诊断延迟仍然是卫生系统面临的主要挑战，但文献中尚未认识到延迟的根源。本研究旨在量化患者和卫生系统的延迟，并确定其相关因素。
本研究基于世界卫生组织（WHO）的公开数据源（2017 年 1 月 2 日至 2018 年 5 月 16 日），对 266 例患者进行研究。使用泊松回归分析计算并建模诊断延迟、患者延迟和卫生系统延迟。
在所研究期间报告的 266 例 MERS-CoV 患者中，中位数诊断延迟、患者延迟和卫生系统延迟分别为 5 天（四分位距[IQR]范围：3-8 天）、4 天（IQR 范围：2-7 天）和 2 天（IQR 范围：1-2 天）。患者延迟（r=0.894，P=0.001）和卫生系统延迟（r=0.163，P=0.025）均与诊断延迟呈正相关。年龄较大与卫生系统延迟较长相关（校正相对比[aRR]，1.011；95%置信区间[CI]，1.004-1.017）。诊断延迟（aRR，1.137；95%CI，1.006-1.285）和卫生系统延迟（aRR，1.217；95%CI，1.003-1.476）在死亡患者中显著更长。
MERS-CoV 诊断存在延迟，可能归因于患者延迟和卫生系统延迟，因为两者与较长的诊断延迟均显著相关。早期 MERS-CoV 诊断可能需要更敏感的风险评估工具来减少可避免的延迟，特别是与患者和卫生系统相关的延迟。
