Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy.
Department of Emergency Medicine, University of Rome Sapienza,Rome, Italy.
Eur J Public Health. 2019 Oct 1;29(5):966-971. doi: 10.1093/eurpub/ckz056.
A large outbreak of measles has spread across Italy over the year 2017. Its impact on emergency department (ED) of a tertiary-care teaching hospital and the related critical issues in public health were evaluated.
Medical records of adults discharged from January to December 2017 with diagnosis of 'measles' or 'measles suspicion' were collected and analyzed.
From a total of 58 579 admissions, 218 medical records matched enrollment criteria. Measles infection was confirmed in 55.3% of patients, excluded in 26.2%, and judged as possible or probable in 18.3% of cases. Considered that the vaccination status was unknown in 89.2% of patients, the mean time spent in temporary isolation rooms (TIRs) waiting serological results was 1.7 ± 0.8 days. Measles-free patients spent a mean of 1.9 ± 0.9 days in TIRs, meaning a cumulative unnecessary time of isolation of 106.4 days. Despite most of patients were pauci-simptomatic and with a low burden of comorbidities, only 28.6% of them reported a previous out-of-hospital medical contact. Moreover an assessment of moderately critical conditions was assigned to 89.6% of cases, representing an over-valuation of the severity of the cases. Antibiotic therapy had been prescribed in 69.0% of cases and 57.7% of patients were hospitalized. We found no differences in terms of median time spent in TIRs, rate of hospitalization and antibiotic prescription between measles cases and measles-free patients.
A preventable high-infective disease outbreak can lead to a misapply of ED facilities in terms of unjustified admissions, time spent in TIRs, antibiotic prescription and in hospitalization rate.
2017 年意大利爆发了大规模麻疹疫情。评估了其对三级教学医院急诊科（ED）的影响以及公共卫生方面的相关关键问题。
收集并分析了 2017 年 1 月至 12 月期间因“麻疹”或“麻疹疑似”出院的成年患者的病历。
在总共 58579 例住院患者中，有 218 例病历符合纳入标准。55.3%的患者麻疹感染得到确诊，26.2%的患者排除麻疹感染，18.3%的患者被判断为可能或疑似麻疹。由于 89.2%的患者疫苗接种情况未知，因此他们在临时隔离室（TIR）等待血清学结果的平均时间为 1.7±0.8 天。无麻疹患者在 TIR 中的平均停留时间为 1.9±0.9 天，这意味着 106.4 天的隔离时间是不必要的。尽管大多数患者症状轻微且合并症负担较低，但只有 28.6%的患者报告了之前的院外医疗接触。此外，89.6%的病例被评估为中度危急情况，这表明对病例严重程度的评估过高。在 69.0%的病例中开具了抗生素治疗，57.7%的患者住院。我们未发现麻疹病例与无麻疹患者在 TIR 停留时间、住院率和抗生素处方方面存在差异。
可预防的高传染性疾病暴发可导致急诊科设施的不合理使用，表现在不必要的住院、在 TIR 中停留的时间、抗生素的使用和住院率方面。
