Hostname: page-component-848d4c4894-sjtt6 Total loading time: 0 Render date: 2024-06-21T02:00:48.885Z Has data issue: false hasContentIssue false
  • English
  • Français

Early clinical predictors of severe acute respiratory syndrome in the emergency department

Published online by Cambridge University Press:  21 May 2015

W.N. Wong ,
Antonio C.H. Sek ,
Rick F.L. Lau ,
K.M. Li ,
Joe K.S. Leung ,
M.L. Tse ,
Andy H.W. Ng  and
Robert J. Stenstrom
W.N. Wong*
Affiliation:
Medical officer
Antonio C.H. Sek
Affiliation:
Medical officer
Rick F.L. Lau
Affiliation:
Chief of Service
K.M. Li
Affiliation:
Consultant
Joe K.S. Leung
Affiliation:
Medical officer
M.L. Tse
Affiliation:
Senior MO, United Christian Hospital Emergency Department, Hong Kong
Andy H.W. Ng
Affiliation:
Senior MO, United Christian Hospital Emergency Department, Hong Kong
Robert J. Stenstrom
Affiliation:
Department of Emergency Medicine, St. Paul’s Hospital, and University of British Columbia, Vancouver, BC.
*
Accident & Emergency Department, United Christian Hospital, Hong Kong; fax 852-23795801, wingnam@email.hkuspace.com

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objectives:

To assess the association of diagnostic predictors available in the emergency department (ED) with the outcome diagnosis of severe acute respiratory syndrome (SARS).

Methods:

This retrospective cohort study describes all patients from the Amoy Garden complex who presented to an ED SARS screening clinic during a 2-month outbreak. Clinical and diagnostic predictors were recorded, along with ED diagnoses. Final diagnoses were established independently based on diagnostic tests performed after the ED visit. Associations of key predictors with the final diagnosis of SARS were described.

Results:

Of 821 patients, 205 had confirmed SARS, 35 undetermined SARS and 581 non-SARS. Multivariable logistic regression showed that the strongest predictors of SARS were abnormal chest x-ray (odds ratio [OR] = 17.4), subjective fever (OR = 9.7), temperature >38°C (OR = 6.4), myalgias (OR = 5.5), chills and rigors (OR = 4.0) and contact exposure (OR = 2.6). In a subset of 176 patients who had a complete blood cell count performed, the strongest predictors were temperature ≥38ºC (OR = 15.5), lymphocyte count <1000 (OR = 9.3) and abnormal chest x-ray (OR = 5.7). Diarrhea was a powerful negative predictor (OR = 0.03) of SARS.

Conclusions:

Two components of the World Health Organization case definition — fever and contact exposure — are helpful for ED decision-making, but respiratory symptoms do not discriminate well between SARS and non-SARS. Emergency physicians should consider the presence of diarrhea, chest x-ray findings, the absolute lymphocyte count and the platelet count as significant modifiers of disease likelihood. Prospective validation of these findings in other clinical settings is desirable.

Keywords

SARSdiagnosisemergency departmentsensitivitysevere acute respiratory syndrome
Type
Em Advances • Innovations En Mu
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 1 , January 2004 , pp. 12 - 21
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

References

1.Lee, N, Hui, D, Wu, A, Chan, P, Cameron, P, Joynt, GM, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med 2003;348(20):1986–94. Epub 2003 Apr 7.CrossRefGoogle Scholar
2.Booth, CM, Matukas, LM, Tomlinson, GA, Rachlis, AR, Rose, DB, Dwosh, HA, et al. Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area [published erratum appears in JAMA 2003;290(3):334]. JAMA 2003;289(21):2801–9. Epub 2003 May 6.CrossRefGoogle Scholar
3.Donnelly, CA, Ghani, AC, Leung, GM, Hedley, AJ, Fraser, C, Riley, S, et al. Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong [published erratum appears in Lancet 2003;361(9371):1832]. Lancet 2003;361(9371):1761–6.CrossRefGoogle Scholar
4.Wong, WN, Sek, ACH, Lau, RFL, Li, KM, Leung, JKS, Tse, ML, et al. Accuracy of clinical diagnosis versus the World Health Organization case definition in the Amoy Garden SARS cohort. Can J Emerg Med 2003;5(6):384–91.CrossRefGoogle ScholarPubMed
5.Worster, A, Innes, G, Abu-Laban, RB.Diagnostic testing: an emergency medicine perspective. Can J Emerg Med 2002;4(5):348–54.Google Scholar
6.Thompson, J.SARS: finding a deadly needle in the haystack. Can J Emerg Med 2003;5(6):392–3.CrossRefGoogle ScholarPubMed
7.Chan, PKS, Ip, M, Ng, KC, Chan, RCW, Wu, A, Lee, N, et al. Severe acute respiratory syndrome — associated coronvirus infection. Emerg Infect Dis [serial online] 2003;9(11):1453–4. Available: www.cdc.gov/ncidod/EID/vol9no11/030421.htm (accessed 2003 Nov 9).CrossRefGoogle Scholar
8.Lee, HKK, Tso, EYK, Chau, TN, Tsang, OTY, Choi, KW, Lai, TST.Asymptomatic severe acute respiratory syndrome — associated coronvirus infection [letter]. Emerg Infect Dis [serial online] 2003;9(11):1491. Available: www.cdc.gov/ncidod/EID/vol9no11/030401.htm (accessed 2003 Nov 9).CrossRefGoogle Scholar