Timothy H. Rainer, MD; Irene O.L. Wong, MPhil, MMedSc; Gabriel M. Leung, MD, MPH
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Rainer T., Wong I., Leung G.; 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
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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.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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