"Med-X": a medical examiner surveillance model for bioterrorism and infectious disease mortality
"Med-X": a medical examiner surveillance model for bioterrorism and infectious disease mortality
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DOI：
10.1016/j.humpath.2007.02.003
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发表时间：
2007-05-01
期刊：
影响因子：
3.3
通讯作者：
Zumwalt, Ross E.
中科院分区：
文献类型：
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作者：
Nolte, Kurt B.;Lathrop, Sarah L.;Zumwalt, Ross E.
我们创建了一个模型监测系统 (Med-X)，旨在使法医和验尸官能够识别具有公共卫生重要性的致命感染和生物恐怖主义造成的死亡。 2000 年 11 月 23 日至 2002 年 11 月 22 日期间在新墨西哥州死亡并属于法医管辖范围内的所有个体均使用一系列监测症状和基于尸检的病理综合征进行了前瞻性评估。对所有传染病死亡进行了评估，以确定具体的病原体。在 6104 例辖区病例中，250 例（4.1%）符合 Med-X 标准，其中 141 例（56.4%）具有目标病理综合征。最终，250 例病例中有 127 例（51%）是由于感染引起的。已确定 103 例（81%）传染病死亡病例的致病微生物，其中 60 例（58.3%）是新墨西哥州的应通报疾病。流感样症状、发烧和呼吸道症状以及脑病或新发癫痫对致命感染的预测值分别为 65%、72% 和 50%，可用作尸检表现标准。在制定监测标准之前，37例（14.8%）的病例通常不会进行尸检，导致尸检工作量增加了1%。 Med-X 是检测法医病例中传染病死亡的有效方法。进行法医尸检和向公共卫生当局报告病例的统一标准加强了对法定传染病的监测，并增加了识别与生物恐怖主义有关的死亡的可能性。 (c) 2007 Elsevier Inc. 保留所有权利。
We created a model surveillance system (Med-X) designed to enable medical examiners and coroners to recognize fatal infections of public health importance and deaths due to bioterrorism. All individuals who died in New Mexico and fell under medical examiner jurisdiction between November 23, 2000, and November 22, 2002, were prospectively evaluated using sets of surveillance symptoms and autopsy-based pathologic syndromes. All infectious disease deaths were evaluated to identify the specific causative agent. Of 6104 jurisdictional cases, 250 (4.1 %) met Med-X criteria, of which 141 (56.4%) had a target pathologic syndrome. Ultimately, 127 (51%) of the 250 cases were due to infections. The causative organism was identified for 103 (81%) of the infectious disease deaths, of which 60 (58.3%) were notifiable conditions in New Mexico. Flu-like symptoms, fever and respiratory symptoms, and encephalopathy or new-onset seizures had predictive values positive for fatal infections of 65%, 72%, and 50%, respectively, and are useful as autopsy performance criteria. Before the development of surveillance criteria, 37 (14.8%) of the cases ordinarily would not have been autopsied resulting in a 1% increase in autopsy workload. Med-X is an effective method of detecting infectious disease deaths among medical examiner cases. Uniform criteria for performing medical examiner autopsies and reporting cases to public health authorities enhance surveillance for notifiable infectious diseases and increase the likelihood of recognizing deaths related to bioterrorism. (c) 2007 Elsevier Inc. All rights reserved.