Kirkland K B, Wilkinson W E, Sexton D J
Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
Clin Infect Dis. 1995 May;20(5):1118-21. doi: 10.1093/clinids/20.5.1118.
We conducted a retrospective cohort study of patients with Rocky Mountain spotted fever (RMSF) at a university hospital in order to assess the relationship between delay in treatment and mortality and to identify predictors of delay in initiating therapy. Patients with RMSF who received antirickettsial therapy within 5 days of the onset of symptoms were significantly less likely to die than were those who received treatment after the 5th day of illness (6.5% vs. 22.9%, respectively; P < .03). Ninety percent of patients were seen by a physician during this 5-day period, yet less than one-half of them received treatment before day 6. Three factors were independent predictors of failure by the physician to initiate therapy the first time a patient was seen: absence of a rash, presentation between 1 August and 30 April, and presentation within the first 3 days of illness. Until reliable early diagnostic tests become available, physicians may be able to decrease the mortality associated with RMSF by instituting empirical treatment of suspected cases within the first 5 days of illness.
我们在一家大学医院对落基山斑疹热（RMSF）患者进行了一项回顾性队列研究，以评估治疗延迟与死亡率之间的关系，并确定开始治疗延迟的预测因素。症状出现后5天内接受抗立克次体治疗的RMSF患者死亡的可能性明显低于发病第5天后接受治疗的患者（分别为6.5%和22.9%；P <.03）。90%的患者在这5天内看过医生，但其中不到一半的患者在第6天之前接受了治疗。医生首次见到患者时未能开始治疗的三个独立预测因素为：无皮疹、8月1日至4月30日之间就诊以及发病后前3天内就诊。在可靠的早期诊断测试出现之前，医生或许可以通过在疾病的前5天内对疑似病例进行经验性治疗来降低与RMSF相关的死亡率。
