论文部分内容阅读
目的 研究严重急性呼吸综合征(SARS)患者的临床和影像学特征并评价世界卫生组织(WHO)关于SARS诊断指南的准确性。 试验设计 前瞻性观察研究。 研究地点 香港新界一所教学医院急诊科新建立的SARS鉴别门诊。 研究对象 有SARS患者接触史的556名医院工作人员、患者及曾访问过该门诊的工作人员和患者的亲属。 主要观察指标 SARS患者的确诊人数。 结果 556名研究对象中,收入院141人,其中97人被确诊为SARS。97例确诊患者中,发热、寒战、乏力、肌痛、畏寒、纳差、呕吐、腹泻、颈痛等非呼吸道症状的发生率均显著高于其他患者。WHO关于诊断可疑SARS患者指南的准确性为83％,其阴性预计值为86％(95％可信区间为83％～89％),敏感性为26％(17％～36％),特异性为96％(93％～97％)。 结论 现行WHO关于诊断可疑SARS患者的指南,用于诊断入院前的患者尚不够敏感,而每天随诊、评价非呼吸道和全身的症状以及胸部X线检查可能是更好的鉴别工具。
Objective To study the clinical and radiographic features of patients with severe acute respiratory syndrome (SARS) and to evaluate the accuracy of the World Health Organization (WHO) guidelines for the diagnosis of SARS. Experimental design prospective observational study. Study Location New SARS Identification Clinic, Emergency Room, a Teaching Hospital, New Territories, Hong Kong. The study involved 556 hospital staff, patients, and staff and patients’ relatives who had been contacted by SARS patients. MAIN OUTCOME MEASURES Number of patients diagnosed with SARS. Results Among the 556 subjects, 141 were hospitalized, of whom 97 were diagnosed as SARS. Among the 97 confirmed patients, the incidence of non-respiratory symptoms such as fever, chills, fatigue, myalgia, chills, anorexia, vomiting, diarrhea and neck pain were significantly higher than those of other patients. The accuracy of WHO guidelines for the diagnosis of patients with suspected SARS was 83%, with a negative predictive value of 86% (95% confidence interval 83% to 89%), sensitivity 26% (17% to 36%), specificity 96% (93% ~ 97%). Conclusions The current WHO guidelines for diagnosing patients with suspected SARS are not yet sensitive enough to diagnose pre-admission patients. However, daily follow-up, evaluation of non-respiratory and systemic symptoms, and chest X-ray may be a better diagnostic tool.