Clinical diagnostic approach to severe acute respiratory syndrome: an institution's experience.

OBJECTIVE: To analyze diagnostic approach to severe acute respiratory syndrome (SARS) according to the diagnostic criteria issued by the Ministry of Health of China (MHC). METHODS: The clinical data and the diagnostic results of 108 cases of SARS were retrospectively reviewed according to the MHC criteria. RESULTS: There were 55 men and 53 women, with a median age of 34.5 years (range, 12 - 78 years). The interval between their first visit and clinical diagnosis was 3 days (range, 0 - 14 days). The diagnosis was made at the first visit in 7 (6.5%, 7/108) cases with a history of exposure to SARS patients and infiltrates on chest radiograph. Eighty-nine (82.4%) and 12 (11.1%) patients were categorized as probable cases and suspected cases respectively at their first visit and a clinical diagnosis of SARS was made subsequently. The interval between first visit and reaching the final diagnosis was 1 - 3 days in 72 (66.7%) cases and 4 days in 29 (26.9%) cases. The final diagnosis was made in 0 - 14 days (median, 2 days) for those (n = 59, 54.6%) with a history of close contact with SARS patients and 2 - 8 days (median, 3 days) for those (n = 49, 45.4%) living in Beijing but without such a history (P = 0.03). The chest radiograph was interpreted as unremarkable in 26 (24.1%) cases at their first visit, and the diagnosis was made in 4 days (range 2 - 8 days), which was significantly longer compared with other cases (P < 0.001). In patients without a history of close contact with SARS patients, all the five criteria were met after combination antibiotic therapy had failed. CONCLUSIONS: A chest radiograph without infiltrates at the early stage of SARS is an important factor responsible for delayed diagnosis. In patients without a history of close contact with SARS cases, antibiotic effect was a major factor influencing doctors' diagnosis.

[Retrospective analysis for first-visiting case data of 272 SARS inpatients in Peking University Third Hospital].

OBJECTIVE: The first-visiting cases of total 272 SARS inpatients admitted in SARS wards in Third Hospital from April 10, 2003 to May 12 were analyzed retrospectively. The clinical characteristics and diagnostic decision for these patients were described. METHODS: The enrollment of inpatients was ruled with two official standards, i.e., 'Clinical Standards for Diagnosis of SARS, Trial Edition' from Health Ministry, and 'Diagnostic Standards for SARS' from Joint Force of Prevention and Therapy for SARS in Beijing, PRC. The present work was based on the first-visiting case records of these SARS inpatients. RESULTS: The characteristics of gender, age, occupation, contagious history and previous therapy were described in SARS inpatients when they visited the outpatient department for SARS in the first time; the clinical symptoms, physical signs, blood WBC counts and X-ray in lungs were also analyzed. In 272 inpatients who were admitted into SARS wards at their first visiting, 145 patients (53.5%) were finally diagnosed as SARS, well as 97 patients (35.7%) were eliminated. CONCLUSION: In the first visiting of the suspectable SARS patients, the contagious history, clinical symptoms, laboratory results and lung X-ray should be studied comprehensively and thoroughly to avoid omitted or mistaken diagnosis. Most final diagnosis came from the revising of the original decision. The advances in SARS virology and immunology may provide more accurate evidences in SARS diagnosis.

[Chest X-ray changes after discontinuation of glucocorticosteroids treatment on severe acute respiratory syndrome (5 cases report)].

OBJECTIVE: To investigate the effect of glucocorticosteroids on severe acute respiratory syndrome (SARS) and chest X ray changes after discontinuation of glucocorticosteroids treatment. METHODS: To retrospectively study the clinical characteristics of 5 cases with SARS and chest X ray changes after discontinuation of glucocorticosteroids. RESULTS: 5 cases were medical workers and had exposure to SARS patients. The incubation periods were 2 to 7 days. They had high fever from the onset of the disease. There were lung infiltrates 1 to 6 days after fever and then methylprednisolone was given to them. Two or three days after glucocorticosteroids treatment, clinical symptoms in these patients were disappeared. The clinical symptoms in case 1, cases 2, case 4 and case 5 weren't deteriorated after discontinuation of methylprednisolone while the presentation in chest X ray was progressed 3-6 days later. No more methylprednisolone was given to the patients and the infiltrates in chest X ray was gradually absorbed in 5-11 days. The temperature in case 3 was elevated again and the shadow in chest X ray was progressed after discontinuation of methylprednisolone due to the low dosage of glucocorticosteroids. When the dosage of methylprednisolone was increased, the temperature tended to be normal and the lung infiltrates began to absorb gradually. CONCLUSION: For the patients with non-severe SARS, if the symptoms were disappeared after discontinuation of glucocorticosteroids, the lung shadow may be progressed. we can closely observe the condition of the disease and no more glucocortisteroids needed to be given to the patients. The lung shadow could be absorbed gradually.