Evaluation of WHO criteria for identifying patients with severe acute respiratory syndrome out of hospital: prospective observational study
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7403.1354 (Published 19 June 2003) Cite this as: BMJ 2003;326:1354
- Timothy H Rainer, associate professor (rainer1091{at}cuhk.edu.hk),
- Peter A Cameron, professor and director,
- DeVilliers Smit, assistant professor,
- Kim L Ong, associate professor,
- Alex Ng Wing Hung, medical officer,
- David Chan Po Nin, medical officer,
- Anil T Ahuja, professor,
- Louis Chan Yik Si, medical officer,
- Joseph J Y Sung, professor
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
- Correspondence to: T H Rainer, Department of Emergency Medicine, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
- Accepted 22 May 2003
Abstract
Objectives To determine the clinical and radiological features of severe acute respiratory syndrome (SARS) and to evaluate the accuracy of the World Health Organization's guidelines on defining cases of SARS.
Design Prospective observational study.
Setting A newly set up SARS screening clinic in the emergency department of a university hospital in Hong Kong's New Territories.
Participants 556 hospital staff, patients, and relatives who attended the screening clinic and who had had contact with someone with SARS.
Main outcome measure Number of confirmed cases of SARS.
Results Of the 556 people, 141 were admitted to hospital, and 97 had confirmed SARS. Fever, chills, malaise, myalgia, rigor, loss of appetite, vomiting, diarrhoea, and neck pain but not respiratory tract symptoms were significantly more common among the 97 patients than among the other patients. The overall accuracy of the WHO guidelines for identifying suspected SARS was 83% and their negative predictive value was 86% (95% confidence interval 83% to 89%). They had a sensitivity of 26% (17% to 36%) and a specificity of 96% (93% to 97%).
Conclusions Current WHO guidelines for diagnosing suspected SARS may not be sufficiently sensitive in assessing patients before admission to hospital. Daily follow up, evaluation of non-respiratory, systemic symptoms, and chest radiography would be better screening tools.
Footnotes
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Details of health advice given to attenders at the screening clinic are on bmj.com -
Competing interests THR had the idea for the study, oversaw its planning and execution and the statistical analysis, and prepared the manuscript. PAC, DS, and KLO participated in the planning, execution, and analysis. ANWH, DCPN, and ATA were responsible for assessment of radiographs and scans. LCYS planned the epidemiological follow up. JJYS supervised the clinical assessment of patients after admission. All authors contributed to the final version of the paper. THR will act as guarantor.
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Funding No additional funding.
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Competing interests None declared.
- Accepted 22 May 2003