Evaluation of anamnestic criteria for the identification of patients with acute community onset viral gastroenteritis in the emergency department--A prospective observational study.

Thomas Andreasson, Lars Gustavsson, Magnus Lindh, Ing-Marie Bergbrant, Christina Raner, Christina Ahrén, Johan Westin, Lars-Magnus Andersson
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引用次数: 2

Abstract

Background: To our knowledge no clinical criteria for the identification of community onset viral gastroenteritis in individual patients have been evaluated systematically with modern PCR-based diagnostic assays as gold standard.

Objective: The aim of this study was to identify factors independently associated with the detection of virus by PCR in rectal swab samples from patients with acute community onset gastroenteritis.

Methods: A prospective observational study was conducted from December 2010 through March 2011 at the emergency department (ED) of a large teaching hospital. All patients who reported vomiting and/or diarrhoea up to 48 h prior to their visit to the ED were asked to participate. A rectal swab sample was obtained from each patient. Symptoms, date of onset, and epidemiological data were recorded. Samples were analysed with a multiple real-time PCR targeting 6 viral agents (astrovirus, adenovirus, rotavirus, sapovirus, and norovirus GI and GII).

Results: Two hundred and five patients fulfilled the inclusion criteria, of whom 66 agreed to participate; their median (IQR) age was 65 (38-84) y and 43 (65%) were females. Thirty-one (47%) were positive by PCR for at least 1 of the agents examined (26 norovirus, 2 sapovirus, 2 rotavirus, and 1 adenovirus). Diarrhoea and a short duration of symptoms (≤ 2 days) were independently associated with a positive rectal swab sample, with odds ratios of 7.5 (95% confidence interval (CI) 2.0-28) and 10.4 (95% CI 1.9-56), respectively (p < 0.01 for both). A multivariate model including these 2 variables had a sensitivity of 81% (25/31) and a specificity of 69% (24/35).

Conclusions: Diarrhoea and a short duration of symptoms were the only anamnestic criteria independently associated with acute community onset viral gastroenteritis confirmed by PCR.

评估急诊科急性社区发病病毒性胃肠炎患者的记忆标准——一项前瞻性观察研究
背景:据我们所知,目前还没有以现代pcr为基础的诊断方法作为金标准来系统评估个体患者社区发病病毒性胃肠炎的临床标准。目的:本研究的目的是确定与急性社区发病胃肠炎患者直肠拭子样本PCR检测病毒独立相关的因素。方法:2010年12月至2011年3月在某大型教学医院急诊科进行前瞻性观察研究。所有在急诊科就诊前48小时报告呕吐和/或腹泻的患者都被要求参与。从每位患者身上获得直肠拭子样本。记录症状、发病日期和流行病学资料。对6种病毒病原(星状病毒、腺病毒、轮状病毒、萨波病毒、诺如病毒GI和GII)进行多重实时PCR分析。结果:225例患者符合纳入标准,其中66例同意参与;中位(IQR)年龄为65岁(38-84岁),女性43岁(65%)。31例(47%)至少1种病原PCR阳性(诺如病毒26例,萨波病毒2例,轮状病毒2例,腺病毒1例)。腹泻和症状持续时间短(≤2天)与直肠拭子样本阳性独立相关,比值比分别为7.5(95%可信区间(CI) 2.0-28)和10.4 (95% CI 1.9-56)(两者p < 0.01)。包含这两个变量的多变量模型的敏感性为81%(25/31),特异性为69%(24/35)。结论:腹泻和症状持续时间短是PCR证实的与急性社区发病病毒性胃肠炎独立相关的唯一健忘标准。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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