Establishing a Clinical Decision Rule of Severe Acute Respiratory Syndrome at the Emergency Department

Tzong Luen Wang, Tsrang Neng Jang, Chien Hsien Huang, Shang Jyh Kao, Chor Ming Lin, Fang Niarn Lee, Cheng Yao Liu, Chee Fah Chong, Chu Mei Lin, Harnod Dorji, Hsueh Ju Teng, Hang Chang

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Study objective: In the absence of reliable rapid confirmatory tests during severe acute respiratory syndrome (SARS) endemics, we designed a 2-phase cohort study to establish a scoring system for SARS and to evaluate whether it could improve the sensitivity and specificity of the World Health Organization (WHO) criteria. Methods: According to the clinical characteristics and initial laboratory findings of 175 suspected cases defined by the WHO criteria (20 confirmed as cases of SARS) in 3 university teaching hospitals in Taipei between March 1 and April 20, 2003, the scoring system for SARS was designed by multivariate analysis and stepwise logistic regression as the simple arithmetic sum of point values assigned to 7 parameters. We thereafter applied the scoring system for SARS to the consecutive 232 patients (the validation group) who met the WHO criteria of suspected cases from April 21 to May 22, 2003. Final diagnosis of SARS was determined by the results of real-time polymerase chain reaction and paired serum. Results: The scoring system for SARS was defined as radiographic findings of multilobar or bilateral infiltrates (3 points), sputum monocyte predominance (3 points), lymphocytopenia (2 points), history of exposure (1 point), lactate dehydrogenase more than 450 U/L (1 point), C-reactive protein more than 5.0 mg/dL (1 point), and activated partial prothrombin time more than 40 seconds (1 point). Of the validation group, 60 patients (group A) were confirmed as having cases of SARS, and the other 172 (group B) patients tested negative for SARS. The total points of the scoring system for SARS at initial presentation were significantly higher in the SARS group (median 9; range 6 to 11) than in the non-SARS group (median 4; range 3 to 7; P

Original languageEnglish
Pages (from-to)17-22
Number of pages6
JournalAnnals of Emergency Medicine
Volume43
Issue number1
DOIs
Publication statusPublished - Jan 2004
Externally publishedYes

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Severe Acute Respiratory Syndrome
Hospital Emergency Service
Lymphopenia
Prothrombin Time
Sputum
Teaching Hospitals
C-Reactive Protein
Real-Time Polymerase Chain Reaction
Monocytes
Cohort Studies
Multivariate Analysis
Logistic Models

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Establishing a Clinical Decision Rule of Severe Acute Respiratory Syndrome at the Emergency Department. / Wang, Tzong Luen; Jang, Tsrang Neng; Huang, Chien Hsien; Kao, Shang Jyh; Lin, Chor Ming; Lee, Fang Niarn; Liu, Cheng Yao; Chong, Chee Fah; Lin, Chu Mei; Dorji, Harnod; Teng, Hsueh Ju; Chang, Hang.

In: Annals of Emergency Medicine, Vol. 43, No. 1, 01.2004, p. 17-22.

Research output: Contribution to journalArticle

Wang, TL, Jang, TN, Huang, CH, Kao, SJ, Lin, CM, Lee, FN, Liu, CY, Chong, CF, Lin, CM, Dorji, H, Teng, HJ & Chang, H 2004, 'Establishing a Clinical Decision Rule of Severe Acute Respiratory Syndrome at the Emergency Department', Annals of Emergency Medicine, vol. 43, no. 1, pp. 17-22. https://doi.org/10.1016/j.annemergmed.2003.08.002
Wang, Tzong Luen ; Jang, Tsrang Neng ; Huang, Chien Hsien ; Kao, Shang Jyh ; Lin, Chor Ming ; Lee, Fang Niarn ; Liu, Cheng Yao ; Chong, Chee Fah ; Lin, Chu Mei ; Dorji, Harnod ; Teng, Hsueh Ju ; Chang, Hang. / Establishing a Clinical Decision Rule of Severe Acute Respiratory Syndrome at the Emergency Department. In: Annals of Emergency Medicine. 2004 ; Vol. 43, No. 1. pp. 17-22.
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AU - Lin, Chor Ming

AU - Lee, Fang Niarn

AU - Liu, Cheng Yao

AU - Chong, Chee Fah

AU - Lin, Chu Mei

AU - Dorji, Harnod

AU - Teng, Hsueh Ju

AU - Chang, Hang

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