Timothy H. Rainer, MD; Irene O.L. Wong, MPhil, MMedSc; Gabriel M. Leung, MD, MPH
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Rainer TH, Wong IO, Leung GM. A Clinical Prediction Rule for the Severe Acute Respiratory Syndrome. Ann Intern Med. 2005;142:225-226. doi: 10.7326/0003-4819-142-3-200502010-00020
Download citation file:
Published: Ann Intern Med. 2005;142(3):225-226.
Ma and colleagues' results after applying our clinical prediction rule confirm the generalizability of the algorithm beyond Hong Kong to another urban population affected by SARS. This satisfies the call by the U.S. Centers for Disease Control and Prevention to externally validate our decision rule to assess its clinical effectiveness for potential future outbreaks (1).
For cross-validation purposes, we applied the Taiwanese rule (2), previously published by Ma's group, to our sample: 2649 emergency department attendees at the Prince of Wales and United Christian Hospitals, which provided care for the 2 largest outbreak clusters in Hong Kong. The Table shows the performance indices associated with both the Hong Kong and Taiwanese decision rules. In the base-case analysis, Ma and colleagues' symptom scoring system achieved a sensitivity of 0.513 and a specificity of 0.583, with an area under the receiver-operating characteristic curve of 0.57; for the clinical scoring system, these values were 0.481, 0.764, and 0.65, respectively. If this rule were applied during a large-scale outbreak, such a low sensitivity and similarly suboptimal performance indices would be unacceptable, given the public health risk associated with false underdiagnosis and potential community transmission by the missed patients.
Learn more about subscription options.
Register Now for a free account.
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only