Prognostic significance of the radiographic pattern of disease in patients with severe acute respiratory syndrome.

OBJECTIVE: This study was performed to evaluate the prognostic significance of the radiographic pattern of disease in probable cases of severe acute respiratory syndrome (SARS). MATERIALS AND METHODS: A retrospective review of 439 radiographs was performed for 51 patients with a final diagnosis of probable SARS. Forty-nine patients were followed up for a mean interval of 23 days (range, 2-63 days). RESULTS: Abnormal findings on a chest radiograph were noted at presentation in 80.4% (41/51) of patients. Four radiographic patterns were seen: normal (group 1) in 19.6% (10/51), focal opacity (group 2) in 39.2% (20/51), multifocal opacities (group 3) in 27.5% (14/51), and diffuse air-space opacification (group 4) in 13.7% (7/51). Radiographic progression of disease occurred in 38.8% (19/49) of the patients in groups 1-4. There were no deaths in groups 1 and 2. In group 3, one (7.7%) of the 13 patients died. Five (71.4%) of the seven patients in group 4 died. Overall, 12.2% (6/49) of the patients died, all of whom had diffuse air-space opacification on the last chest radiograph. In these patients, medical comorbidity was present in 66.7% (4/6), and the exposure history was known in 83.3% (5/6). Death occurred at a mean interval of 18.2 days (range, 9-36 days) from the initial exposure. CONCLUSION: Patients presenting with normal findings or focal air-space opacity on chest radiographs had a good clinical outcome. Patients with multifocal opacities that progressed to diffuse air-space opacification and patients presenting with diffuse air-space opacification had a high fatality rate, but patients in this group were also older and more likely to have comorbid conditions. Patients with SARS present with recognizable patterns of disease that have prognostic significance.

Identification and containment of an outbreak of SARS in a community hospital.

BACKGROUND: Severe acute respiratory syndrome (SARS) is continuing to spread around the world. All hospitals must be prepared to care for patients with SARS. Thus, it is important to understand the transmission of this disease in hospitals and to evaluate methods for its containment in health care institutions. We describe how we cared for the first 2 patients with SARS admitted to our 419-bed community hospital in Richmond Hill, Ont., and the response to a SARS outbreak within our institution. METHODS: We collected clinical and epidemiological data about patients and health care workers at our institution who during a 13-day period had a potential unprotected exposure to 2 patients whose signs and symptoms were subsequently identified as meeting the case definition for probable SARS. The index case at our hospital was a patient who was transferred to our intensive care unit (ICU) from a referral hospital on Mar. 16, 2003, where he had been in close proximity to the son of the individual with the first reported case of SARS in Toronto. After 13 days in the ICU, a diagnosis of probable SARS was reached for our index case. Immediately upon diagnosis of our index case, respiratory isolation and barrier precautions were instituted throughout our hospital and maintained for a period of 10 days, which is the estimated maximum incubation period reported for this disease. Aggressive surveillance measures among hospital staff, patients and visitors were also maintained during this time. RESULTS: During the surveillance period, 15 individuals (10 hospital staff, 3 patients and 2 visitors) were identified as meeting the case definition for probable or suspected SARS, in addition to our index case. All but 1 individual had had direct contact with a symptomatic patient with SARS during the period of unprotected exposure. No additional cases were identified after infection control precautions had been implemented for 8 days. No cases of secondary transmission were identified in the 21 days following the implementation of these precautions at our institution. INTERPRETATION: SARS can easily be spread by direct personal contact in the hospital setting. We found that the implementation of aggressive infection control measures is effective in preventing further transmission of this disease.