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Article: A clinical prediction rule for diagnosing severe acute respiratory syndrome in the emergency department

TitleA clinical prediction rule for diagnosing severe acute respiratory syndrome in the emergency department
Authors
Issue Date2004
PublisherAmerican College of Physicians. The Journal's web site is located at http://www.annals.org
Citation
Annals Of Internal Medicine, 2004, v. 141 n. 5, p. 333-342+I-12 How to Cite?
AbstractBackground: Accurate, objective models of triage for patients with suspected severe acute respiratory syndrome (SARS) could assess risks and improve decisions about isolation and inpatient treatment. Objective: To develop and validate a clinical prediction rule for identifying patients with SARS in an emergency department setting. Design: Retrospective analysis using a 2-step coefficient-based multivariable logistic regression scoring method with internal validation by bootstrapping. Setting: 2 hospitals in Hong Kong. Participants: 1274 consecutive patients from 1 hospital and 1375 consecutive patients from another hospital. Measurements: Points were assigned on the basis of history, physical examination, and simple investigations obtained at presentation. The outcome measure was a final diagnosis of SARS, as confirmed by World Health Organization laboratory criteria. Results: Predictors for SARS on the basis of history (step 1) included previous contact with a patient with SARS and the presence of fever, myalgia, and malaise. Age 65 years and older and younger than 18 years and the presence of sputum, abdominal pain, sore throat, and rhinorrhea were inversely related to having SARS. In step 2, haziness or pneumonic consolidation on chest radiographs and low lymphocyte and platelet counts, in addition to a positive contact history and fever were associated with a higher probability of SARS. A high neutrophil count, the extremes of age, and sputum production were associated with a lower probability of SARS. In the derivation sample, the observed incidence of SARS was 4.4% for those assigned to the low-risk group (in steps 1 or 2); in the high-risk group, incidence of SARS was 21.0% for quartile 1, 39.5% for quartile 2, 61.2% for quartile 3, and 79.7% for quartile 4. This prediction rule achieved an optimism-corrected sensitivity of 0.90, a specificity of 0.62, and an area under the receiver-operating characteristic curve of 0.85. Limitations: The prediction rule may not apply to isolated cases occurring during an interepidemic period. Generalizability of the findings should be confirmed in other SARS-affected countries and should be prospectively validated if SARS returns. Conclusions: Our findings suggest that a simple model that uses clinical data at the time of presentation to an emergency department during an acute outbreak predicted the incidence of SARS and provided good diagnostic utility.
Persistent Identifierhttp://hdl.handle.net/10722/151603
ISSN
2015 Impact Factor: 16.44
2015 SCImago Journal Rankings: 5.378
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorLeung, GMen_HK
dc.contributor.authorRainer, THen_HK
dc.contributor.authorLau, FLen_HK
dc.contributor.authorWong, IOLen_HK
dc.contributor.authorTong, Aen_HK
dc.contributor.authorWong, TWen_HK
dc.contributor.authorKong, JHBen_HK
dc.contributor.authorHedley, AJen_HK
dc.contributor.authorLam, THen_HK
dc.date.accessioned2012-06-26T06:25:21Z-
dc.date.available2012-06-26T06:25:21Z-
dc.date.issued2004en_HK
dc.identifier.citationAnnals Of Internal Medicine, 2004, v. 141 n. 5, p. 333-342+I-12en_HK
dc.identifier.issn0003-4819en_HK
dc.identifier.urihttp://hdl.handle.net/10722/151603-
dc.description.abstractBackground: Accurate, objective models of triage for patients with suspected severe acute respiratory syndrome (SARS) could assess risks and improve decisions about isolation and inpatient treatment. Objective: To develop and validate a clinical prediction rule for identifying patients with SARS in an emergency department setting. Design: Retrospective analysis using a 2-step coefficient-based multivariable logistic regression scoring method with internal validation by bootstrapping. Setting: 2 hospitals in Hong Kong. Participants: 1274 consecutive patients from 1 hospital and 1375 consecutive patients from another hospital. Measurements: Points were assigned on the basis of history, physical examination, and simple investigations obtained at presentation. The outcome measure was a final diagnosis of SARS, as confirmed by World Health Organization laboratory criteria. Results: Predictors for SARS on the basis of history (step 1) included previous contact with a patient with SARS and the presence of fever, myalgia, and malaise. Age 65 years and older and younger than 18 years and the presence of sputum, abdominal pain, sore throat, and rhinorrhea were inversely related to having SARS. In step 2, haziness or pneumonic consolidation on chest radiographs and low lymphocyte and platelet counts, in addition to a positive contact history and fever were associated with a higher probability of SARS. A high neutrophil count, the extremes of age, and sputum production were associated with a lower probability of SARS. In the derivation sample, the observed incidence of SARS was 4.4% for those assigned to the low-risk group (in steps 1 or 2); in the high-risk group, incidence of SARS was 21.0% for quartile 1, 39.5% for quartile 2, 61.2% for quartile 3, and 79.7% for quartile 4. This prediction rule achieved an optimism-corrected sensitivity of 0.90, a specificity of 0.62, and an area under the receiver-operating characteristic curve of 0.85. Limitations: The prediction rule may not apply to isolated cases occurring during an interepidemic period. Generalizability of the findings should be confirmed in other SARS-affected countries and should be prospectively validated if SARS returns. Conclusions: Our findings suggest that a simple model that uses clinical data at the time of presentation to an emergency department during an acute outbreak predicted the incidence of SARS and provided good diagnostic utility.en_HK
dc.languageengen_US
dc.publisherAmerican College of Physicians. The Journal's web site is located at http://www.annals.orgen_HK
dc.relation.ispartofAnnals of Internal Medicineen_HK
dc.subject.meshAdulten_US
dc.subject.meshAgeden_US
dc.subject.meshDecision Makingen_US
dc.subject.meshEmergency Service, Hospitalen_US
dc.subject.meshFemaleen_US
dc.subject.meshHumansen_US
dc.subject.meshLogistic Modelsen_US
dc.subject.meshMaleen_US
dc.subject.meshMedical History Takingen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshPredictive Value Of Testsen_US
dc.subject.meshRetrospective Studiesen_US
dc.subject.meshRisk Factorsen_US
dc.subject.meshSevere Acute Respiratory Syndrome - Diagnosisen_US
dc.titleA clinical prediction rule for diagnosing severe acute respiratory syndrome in the emergency departmenten_HK
dc.typeArticleen_HK
dc.identifier.emailLeung, GM: gmleung@hkucc.hku.hken_HK
dc.identifier.emailWong, IOL: iolwong@hku.hken_HK
dc.identifier.emailHedley, AJ: hrmrajh@hkucc.hku.hken_HK
dc.identifier.emailLam, TH: hrmrlth@hkucc.hku.hken_HK
dc.identifier.authorityLeung, GM=rp00460en_HK
dc.identifier.authorityWong, IOL=rp01806en_HK
dc.identifier.authorityHedley, AJ=rp00357en_HK
dc.identifier.authorityLam, TH=rp00326en_HK
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.pmid15326019-
dc.identifier.scopuseid_2-s2.0-19244365125en_HK
dc.identifier.hkuros95416-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-19244365125&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume141en_HK
dc.identifier.issue5en_HK
dc.identifier.spage333en_HK
dc.identifier.epage342+Ien_HK
dc.identifier.isiWOS:000223733800001-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridLeung, GM=7007159841en_HK
dc.identifier.scopusauthoridRainer, TH=7004489495en_HK
dc.identifier.scopusauthoridLau, FL=7102749577en_HK
dc.identifier.scopusauthoridWong, IOL=7102513940en_HK
dc.identifier.scopusauthoridTong, A=7103351485en_HK
dc.identifier.scopusauthoridWong, TW=23570135100en_HK
dc.identifier.scopusauthoridKong, JHB=8632041300en_HK
dc.identifier.scopusauthoridHedley, AJ=7102584095en_HK
dc.identifier.scopusauthoridLam, TH=7202522876en_HK

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