Division of Infectious Diseases and Tropical Medicine, University Hospital (LMU), Leopoldstr. 5, 80802, Munich, Germany.
Institute of Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public Health, Ludwig Maximilian University Munich, Marchioninistr, 15, 81377, Munich, Germany.
BMC Infect Dis. 2020 Nov 12;20(1):838. doi: 10.1186/s12879-020-05573-8.
A functioning Viral Haemorrhagic Fever (VHF) surveillance system in countries at risk for outbreaks can reduce early transmission in case of an outbreak. Surveillance performance depends on the application of suspect case definitions in daily clinical practice. Recommended suspect case criteria during outbreaks are designed for high sensitivity and include general symptoms, pyrexia, haemorrhage, epidemiological link and unexplained death in patients. Non-outbreak criteria are narrower, relying on the persistence of fever and the presence of haemorrhagic signs.
This study ascertains VHF suspect case prevalence based on outbreak and non-outbreak criteria in a Guinean regional hospital for a period of three months. The study further describes clinical trajectories of patients who meet non-outbreak VHF suspect case criteria in order to discuss challenges in their identification. We used cross-sectional data collection at triage and emergency room to record demographic and clinical data of all admitted patients during the study period. For the follow-up study with description of diagnostic trajectories of VHF suspect cases, we used retrospective chart review.
The most common symptoms of all patients upon admission were fever, tiredness/weakness and abdominal pain. 686 patients met EVD outbreak criteria, ten adult patients and two paediatric patients met study-specific non-outbreak VHF suspect case criteria. None of the suspect cases was treated as VHF suspect case and none tested positive for malaria upon admission. Their most frequent discharge diagnosis was unspecific gastrointestinal infection. The most common diagnostic measures were haemoglobin level and glycaemia for both adults and for children; of the requested examinations for hospitalized suspect cases, 36% were not executed or obtained. Half of those patients self-discharged against medical advice.
Our study shows that the number of VHF suspect cases may vary greatly depending on which suspect case criteria are applied. Identification of VHF suspect cases seems challenging in clinical practice. We suggest that this may be due to the low use of laboratory diagnostics to support certain diagnoses and the non-application of VHF suspect case definitions in clinical practice. Future VHF suspect case management should aim to tackle such challenges in comparable hospital settings.
在有暴发风险的国家，一个运作良好的病毒性出血热（VHF）监测系统可以减少暴发时的早期传播。监测性能取决于在日常临床实践中应用疑似病例定义。暴发期间推荐的疑似病例标准旨在提高敏感性，包括一般症状、发热、出血、流行病学联系和患者不明原因死亡。非暴发标准较窄，依赖于发热的持续存在和出血迹象的存在。
本研究在三个月的时间内，根据暴发和非暴发标准，确定了几内亚一家地区医院的 VHF 疑似病例患病率。该研究进一步描述了符合非暴发 VHF 疑似病例标准的患者的临床轨迹，以讨论其识别面临的挑战。我们在分诊和急诊室使用横断面数据收集方法，记录研究期间所有入院患者的人口统计学和临床数据。对于后续的 VHF 疑似病例诊断轨迹描述研究，我们使用回顾性图表审查。
所有入院患者最常见的症状是发热、乏力/虚弱和腹痛。686 例患者符合埃博拉病毒病暴发标准，10 例成年患者和 2 例儿科患者符合研究特定的非暴发 VHF 疑似病例标准。没有一例疑似病例被视为 VHF 疑似病例，也没有一例在入院时检测出疟疾阳性。他们最常见的出院诊断是不明原因的胃肠道感染。最常见的诊断措施是成人和儿童的血红蛋白水平和血糖；在要求对住院疑似病例进行的检查中，有 36%未执行或获得。其中一半的患者未经医疗建议就自行出院。
我们的研究表明，根据应用的疑似病例标准，VHF 疑似病例的数量可能有很大差异。疑似 VHF 病例的识别在临床实践中似乎具有挑战性。我们建议，这可能是由于实验室诊断的使用较低，无法支持某些诊断，以及 VHF 疑似病例定义未在临床实践中应用。未来的 VHF 疑似病例管理应旨在解决类似医院环境中的这些挑战。
