Leung et al developed a clinical prediction rule for diagnosing the Severe Acute Respiratory Syndrome (SARS) in the Emergency Department. This involves 2 scores - Step 1 and Step 2. The authors are from multiple hospitals in Hong Kong and the Hospital Authority SARS Collaborative Group.
Patient selection: patient coming to the ED with respiratory complaints during SARS outbreak
Parameters:
(1) age in years
(2) contact history
(3) fever on presentation (tympanic temperature >= 38°C)
(4) myalgia on presentation
(5) malaise on presentation
(6) sputum on presentation
(7) abdominal pain on presentation
(8) sore throat on presentation
(9) rhinorrhea on presentation
|
Parameter
|
Finding
|
Points
|
|
age in years
|
< 18 years
|
-1
|
|
|
18 to 64 years of age
|
0
|
|
|
>= 65 years of age
|
-5
|
|
contact history
|
no
|
0
|
|
|
yes
|
8
|
|
fever on presentation
|
no
|
0
|
|
|
yes
|
15
|
|
myalgia on presentation
|
no
|
0
|
|
|
yes
|
3
|
|
malaise on presentation
|
no
|
0
|
|
|
yes
|
3
|
|
sputum on presentation
|
no
|
0
|
|
|
yes
|
-4
|
|
abdominal pain on presentation
|
no
|
0
|
|
|
yes
|
-8
|
|
sore throat on presentation
|
no
|
0
|
|
|
yes
|
-5
|
|
rhinorrhea on presentation
|
no
|
0
|
|
|
yes
|
-4
|
total score for step 1 =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: -27
• maximum score: +29
• A score >= -3 indicates a high-risk group.
• A score < -3 indicates a low-risk group.
Performance:
• The Step 1 score has a sensitivity of 99%.
