Giancarlo Ceccarelli1, Ornella Spagnolello2, Cristian Borrazzo3, Francesco Vullo4,5, Maria Rosaria Cuomo2, Mimosa Milocco2, Silvia Angeletti6, Massimo Ciccozzi7, Claudio M Mastroianni1, Gabriella d'Ettorre1, Giuliano Bertazzoni2. 1. Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy. 2. Department of Emergency Medicine, University of Rome Sapienza,Rome, Italy. 3. Statistical Unit, Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy. 4. Interventional Cardiology, Infermi Hospital, Rivoli and San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy. 5. Department of Radiological, Oncological and Anatomo Pathological Sciences, University of Rome Sapienza, Rome, Italy. 6. Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy. 7. Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy.
Abstract
BACKGROUND: A large outbreak of measles has spread across Italy over the year 2017. Its impact on emergency department (ED) of a tertiary-care teaching hospital and the related critical issues in public health were evaluated. METHODS: Medical records of adults discharged from January to December 2017 with diagnosis of 'measles' or 'measles suspicion' were collected and analyzed. RESULTS: From a total of 58 579 admissions, 218 medical records matched enrollment criteria. Measles infection was confirmed in 55.3% of patients, excluded in 26.2%, and judged as possible or probable in 18.3% of cases. Considered that the vaccination status was unknown in 89.2% of patients, the mean time spent in temporary isolation rooms (TIRs) waiting serological results was 1.7 ± 0.8 days. Measles-free patients spent a mean of 1.9 ± 0.9 days in TIRs, meaning a cumulative unnecessary time of isolation of 106.4 days. Despite most of patients were pauci-simptomatic and with a low burden of comorbidities, only 28.6% of them reported a previous out-of-hospital medical contact. Moreover an assessment of moderately critical conditions was assigned to 89.6% of cases, representing an over-valuation of the severity of the cases. Antibiotic therapy had been prescribed in 69.0% of cases and 57.7% of patients were hospitalized. We found no differences in terms of median time spent in TIRs, rate of hospitalization and antibiotic prescription between measles cases and measles-free patients. CONCLUSION: A preventable high-infective disease outbreak can lead to a misapply of ED facilities in terms of unjustified admissions, time spent in TIRs, antibiotic prescription and in hospitalization rate.
BACKGROUND: A large outbreak of measles has spread across Italy over the year 2017. Its impact on emergency department (ED) of a tertiary-care teaching hospital and the related critical issues in public health were evaluated. METHODS: Medical records of adults discharged from January to December 2017 with diagnosis of 'measles' or 'measles suspicion' were collected and analyzed. RESULTS: From a total of 58 579 admissions, 218 medical records matched enrollment criteria. Measles infection was confirmed in 55.3% of patients, excluded in 26.2%, and judged as possible or probable in 18.3% of cases. Considered that the vaccination status was unknown in 89.2% of patients, the mean time spent in temporary isolation rooms (TIRs) waiting serological results was 1.7 ± 0.8 days. Measles-free patients spent a mean of 1.9 ± 0.9 days in TIRs, meaning a cumulative unnecessary time of isolation of 106.4 days. Despite most of patients were pauci-simptomatic and with a low burden of comorbidities, only 28.6% of them reported a previous out-of-hospital medical contact. Moreover an assessment of moderately critical conditions was assigned to 89.6% of cases, representing an over-valuation of the severity of the cases. Antibiotic therapy had been prescribed in 69.0% of cases and 57.7% of patients were hospitalized. We found no differences in terms of median time spent in TIRs, rate of hospitalization and antibiotic prescription between measles cases and measles-free patients. CONCLUSION: A preventable high-infective disease outbreak can lead to a misapply of ED facilities in terms of unjustified admissions, time spent in TIRs, antibiotic prescription and in hospitalization rate.
Authors: Riccardo Serra; Cristian Borrazzo; Paolo Vassalini; Chiara Di Nicolantonio; Alexia E Koukopoulos; Cecilia Tosato; Flavio Cherubini; Francesco Alessandri; Giancarlo Ceccarelli; Claudio Maria Mastroianni; Gabriella D'Ettorre; Lorenzo Tarsitani Journal: Int J Environ Res Public Health Date: 2022-07-11 Impact factor: 4.614