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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, [email protected]

Abstract

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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

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