Early diagnosis of SARS: lessons from the Toronto SARS outbreak.
Early diagnosis of SARS: lessons from the Toronto SARS outbreak.
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DOI：
10.1007/s10096-006-0127-x
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发表时间：
2006-04
期刊：
影响因子：
--
通讯作者：
Canadian SARS Research Network
中科院分区：
文献类型：
--
作者：
Muller MP;Richardson SE;McGeer A;Dresser L;Raboud J;Mazzulli T;Loeb M;Louie M;Canadian SARS Research Network
SARS的临床表现是非特异性的，诊断测试不能在疾病过程的早期提供准确的结果。初步诊断仍然依赖于临床评估。为了确定SARS诊断中有用的临床评估特征，我们确定了多伦多SARS爆发期间所有因疑似SARS入院的成人患者的暴露状态、患病率和症状、体征、实验室和放射学检查结果的发生时间。结果进行了比较，在实验室确诊的SARS患者和那些SARS被排除在实验室或公共卫生调查。在364例病例中，273例（75%）已确诊SARS，30例（8%）被排除，61例（17%）仍不确定。在确诊病例中，接触发生在医疗保健环境（80%）或受影响患者的家庭（17%）;社区或旅行相关病例很少（<3%）。97%的患者在入院时出现发热。包括咳嗽、呼吸困难和肺浸润在内的呼吸系统表现出现较晚，入院时分别仅59、37和68%的患者出现。直接接触、发病第一天发热、入院时体温升高、肺浸润、淋巴细胞减少和血小板减少与确诊病例有关。鼻漏、咽喉痛和入院时中性粒细胞计数升高与排除病例相关。在没有发烧或严重暴露的情况下，SARS不太可能发生。其他临床、实验室和放射学发现进一步提高或降低了SARS的可能性，并为估计SARS的可能性和指导初始管理提供了合理的基础。
The clinical presentation of SARS is nonspecific and diagnostic tests do not provide accurate results early in the disease course. Initial diagnosis remains reliant on clinical assessment. To identify features of the clinical assessment that are useful in SARS diagnosis, the exposure status and the prevalence and timing of symptoms, signs, laboratory and radiographic findings were determined for all adult patients admitted with suspected SARS during the Toronto SARS outbreak. Findings were compared between patients with laboratory-confirmed SARS and those in whom SARS was excluded by laboratory or public health investigation. Of 364 cases, 273 (75%) had confirmed SARS, 30 (8%) were excluded, and 61 (17%) remained indeterminate. Among confirmed cases, exposure occurred in the healthcare environment (80%) or in the households of affected patients (17%); community or travel-related cases were rare (<3%). Fever occurred in 97% of patients by the time of admission. Respiratory findings including cough, dyspnea and pulmonary infiltrates evolved later and were present in only 59, 37 and 68% of patients, respectively, at admission. Direct exposure, fever on the first day of illness, and elevated temperature, pulmonary infiltrates, lymphopenia and thrombocytopenia at admission were associated with confirmed cases. Rhinorrhea, sore throat, and an elevated neutrophil count at admission were associated with excluded cases. In the absence of fever or significant exposure, SARS is unlikely. Other clinical, laboratory and radiographic findings further raise or lower the likelihood of SARS and provide a rational basis for estimating the likelihood of SARS and directing initial management.
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影响因子：
11.8
作者：
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通讯作者：
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