The early diagnosis of suspected r...

The early diagnosis of suspected rigorous acute respiratory syndrome (SARS) is essential to allow for early isolation and treatment. The case definition discloseed by the World Health Organization (WHO) defines a suspect case as a patient with high febrile affection cough or breathing difficulty, and direct position or travel through a SARS-affected region within 10 days before symptom charge A probable case meets the criteria for a suspect case and has additional chest radiographic evidence of infiltrates or laboratory be the effects positive for SARS coronavirus. The use of these criteria alone, however, may deduction in underdiagnosis. Leung and associates disentangleed a clinical prediction rule for diagnosis to identify SARS in the push department during an outbreak.

Clinical and laboratory data from patients presenting to the SARS triage clinics of sum of two units large hospitals in Hong Kong were abstracted for analysis at the authors. Using cohorts of patients treated during SARS outbreaks with a SARS diagnosis confirmed on laboratory testing, a two-step prediction order was derived. Step one identified the subgroup of patients likely to have SARS and ne further evaluation, and degree two involved analyzing this high-risk population for radiologic and laboratory characteristics.

In grade one, age in years and contact history were associated with a SARS diagnosis, as was the air of three symptoms: fever, myalgia, and malaise. The absence of sputum production, abdominal pain, sore throat, and rhinorrhea also were independently associated with a SARS diagnosis.

In degree two, four laboratory or radiographic findings were associated with a SARS diagnosis, including chest radiograph, lymphocyte enumerate neutrophil count, and platelet deem After inclusion of step brace investigations, several of the historical and physical finding factors no longer achieved statistical significance.

The scoring regularity used to quantify the association of certain risk factors with SARS are listed in the accompanying table. The higher the score beyond 8 the higher the risk of SARS, with a risk score of 19 or greater representing the highest-risk arrange Using this prediction rule achieved a sensitivity of 090 and a specificity of 062 An internal validation exercise showed religious results.

The authors gather that this prediction rule for SARS risk would allow rapid triage of patients. Patients designated as grave risk could be sent household with daily follow-up for the four- to five-day incubation period that go before s the severe clinical syndrome. Patients whose risk score overstep the proper limits 8 should be admitted with scope allocation guided by the total risk score. Prospective validation of this clinical prediction sway is needed if SARS returns

RICHARD SADOVSKY, MD

Leung GM et al. A clinical prediction method for diagnosing severe acute respiratory syndrome in the extremity department. Ann Intern Med 2004;141:333-42

EDITOR'S NOTE: Epidemiologic studies of strict acute respiratory syndrome coronavirus hint that a repeat epidemic from infected animals or laboratory-stored specimens is possible. In an accompanying editorial, Jernigan and associates (1) note the ne for better diagnostic techniques in the first not many days of illness. The clinical prediction behavior described above may be useful, if it be not that external validation is essential because of epidemiologic variables that have been occurring among affected arranges in different settings and geographic regions. It also is unclear that a prediction behavior derived during an epidemic will be helpful in sporadic cases noted between outbreaks.

REFERENCE

(1) Jernigan JA, Helfand RF Parashar UD Accurate clinical prediction of hard acute respiratory syndrome: are we there yet? Ann Intern M 2004;141:396-8

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