University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.
Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Sri Jayewardenepura, Sri Lanka.
BMC Health Serv Res. 2023 Feb 21;23(1):177. doi: 10.1186/s12913-023-09169-1.
Despite advancements in diagnostic technology, pyrexia of unknown origin (PUO) remains a clinical concern. Insufficient information is available regarding the cost of care for the management of PUO in the South Asian Region.
We retrospectively analyzed data of patients with PUO from a tertiary care hospital in Sri Lanka to determine the clinical course of PUO and the burden of the cost incurred in the treatment of PUO patients. Non-parametric tests were used for statistical calculations.
A total of 100 patients with PUO were selected for the present study. The majority were males (n = 55; 55.0%). The mean ages of male and female patients were 49.65 (SD: 15.55) and 46.87 (SD: 16.19) years, respectively. In the majority, a final diagnosis had been made (n = 65; 65%). The mean number of days of hospital stay was 15.16 (SD; 7.81). The mean of the total number of fever days among PUO patients was 44.47 (SD: 37.66). Out of 65 patients whose aetiology was determined, the majority were diagnosed with an infection (n = 47; 72.31%) followed by non-infectious inflammatory disease (n = 13; 20.0%) and malignancies (n = 5; 7.7%). Extrapulmonary tuberculosis was the most common infection detected (n = 15; 31.9%). Antibiotics had been prescribed for the majority of the PUO patients (n = 90; 90%). The mean direct cost of care per PUO patient was USD 467.79 (SD: 202.81). The mean costs of medications & equipment and, investigations per PUO patient were USD 45.33 (SD: 40.13) and USD 230.26 (SD: 114.68) respectively. The cost of investigations made up 49.31% of the direct cost of care per patient.
Infections, mainly extrapulmonary tuberculosis was the most common cause of PUO while a third of patients remained undiagnosed despite a lengthy hospital stay. PUO leads to high antibiotic usage, indicating the need for proper guidelines for the management of PUO patients in Sri Lanka. The mean direct cost of care per PUO patient was USD 467.79. The cost of investigations contributed mostly to the direct cost of care for the management of PUO patients.
尽管诊断技术有所进步，但不明原因发热（PUO）仍然是一个临床关注的问题。关于南亚地区管理 PUO 的护理成本，目前可用的信息有限。
我们回顾性分析了斯里兰卡一家三级保健医院的 PUO 患者数据，以确定 PUO 的临床过程和治疗 PUO 患者所产生的费用负担。使用非参数检验进行统计计算。
本研究共纳入 100 例 PUO 患者。大多数为男性（n=55；55.0%）。男性和女性患者的平均年龄分别为 49.65（SD：15.55）岁和 46.87（SD：16.19）岁。大多数患者（n=65；65.0%）最终做出了诊断。平均住院天数为 15.16（SD；7.81）天。PUO 患者的平均发热天数为 44.47（SD：37.66）天。在确定病因的 65 例患者中，大多数被诊断为感染（n=47；72.31%），其次是非感染性炎症性疾病（n=13；20.0%）和恶性肿瘤（n=5；7.7%）。最常见的感染是肺外结核（n=15；31.9%）。大多数 PUO 患者（n=90；90.0%）接受了抗生素治疗。每位 PUO 患者的平均直接护理费用为 467.79 美元（SD：202.81）。每位 PUO 患者的药物和设备以及检查费用分别为 45.33 美元（SD：40.13）和 230.26 美元（SD：114.68）。检查费用占每位患者直接护理费用的 49.31%。
感染，主要是肺外结核是 PUO 最常见的原因，尽管住院时间长，但仍有三分之一的患者未被诊断。PUO 导致抗生素使用率高，表明需要为斯里兰卡的 PUO 患者管理制定适当的指南。每位 PUO 患者的平均直接护理费用为 467.79 美元。检查费用对管理 PUO 患者的直接护理费用贡献最大。
