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The rationale of fever surveillance to identify patients with severe acute respiratory syndrome in Taiwan

¹ Department of Emergency Medicine, Veteran’s General Hospital, Taipei, Taiwan
² Chest Department, Veteran’s General Hospital, Taipei, Taiwan
³ Information Service Center, Veteran’s General Hospital, Taipei, Taiwan
⁴ National Yang-Ming University
⁵ National Defense Medical Center

Correspondence to:
Correspondence to:
Dr L-M Wang
Department of Emergency Medicine, Veteran’s General Hospital, Taipei, No 201, Sec 2, Shin-Pai Road, Taipei, Taiwan 10016; lmwang{at}vghtpe.gov.tw

Study objective: To establish a predictive scoring system and to determine its effectiveness for severe acute respiratory syndrome (SARS) cases confirmed by RT-PCR in patients with fever.

Methods: A study was conducted of 484 consecutive patients seen in the emergency department (ED) of our tertiary care center during the SARS outbreak in Taiwan. The scoring system was divided into triage and screening station stages. Data were analysed with multivariable and logistic regression analysis.

Results: Of 737 patients who presented to our ED for possible SARS from March to June 2003, we enrolled 484 patients with a temperature >38.0°C (>100.3°F) (age >18 years). Dyspnoea, diarrhoea, travel, close contact, hospital exposure, and household history were identified as predictive indicators in the triage stage. The triage score was the total of six items. With a one-point cutoff value, the sensitivity and specificity were 81.8% (18/22) and 73.6% (340/462). Leukocytosis, thrombocytopenia, lymphopenia, and CXR were identified as predictive indicators in the fever screening stage. Screening station scores (the sum of 10 items) consisted of triage scores, white blood cell count, and CXR. With a three-point cutoff value, the sensitivity and specificity were 95.5% (21/22) and 87.2% (403/462).

Conclusions: Syndromic and traditional surveillance play a role in early identification of SARS in an endemic area. The SARS scoring system described is easily applicable and highly effective in screening patients during outbreaks.

Abbreviations: CBC, complete blood count; CDC, Centers for Disease Control and Prevention; CXR, chest x ray; DOH, Department of Health; SARS, severe acute respiratory syndrome; WHO, World Health Organization

Keywords: SARS; RT-PCR; scoring system; fever; triage

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