Safety and cost savings of reducing adult dengue hospitalization in a tertiary care hospital in Singapore
| Autor: | Yee Sin Leo, Luis R. Carrasco, Tun L. Thein, Vernon J. Lee, Victor C. Gan, David C. Lye, Arul Earnest, Linda K. Lee |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male Pediatrics medicine.medical_specialty Admission criteria Dengue fever law.invention Cohort Studies Dengue Tertiary Care Centers Hypoproteinemia Patient Admission law medicine Humans Fluid accumulation Retrospective Studies Arbovirus Singapore business.industry Public Health Environmental and Occupational Health virus diseases Original Articles Health Care Costs General Medicine Tertiary care hospital medicine.disease Triage Intensive care unit Cost savings Hospitalization Infectious Diseases Dengue hemorrhagic fever Female Parasitology Outpatient management business |
| Zdroj: | Transactions of the Royal Society of Tropical Medicine and Hygiene |
| ISSN: | 1878-3503 0035-9203 |
| DOI: | 10.1093/trstmh/trs009 |
| Popis: | Background Previously, most dengue cases in Singapore were hospitalized despite low incidence of dengue hemorrhagic fever (DHF) or death. To minimize hospitalization, the Communicable Disease Centre at Tan Tock Seng Hospital (TTSH) in Singapore implemented new admission criteria which included clinical, laboratory, and DHF predictive parameters in 2007. Method All laboratory-confirmed dengue patients seen at TTSH during 2006–2008 were retrospectively reviewed for clinical data. Disease outcome and clinical parameters were compared over the 3 years. Results There was a 33.0% mean decrease in inpatients after the new criteria were implemented compared with the period before (p < 0.001). The proportion of inpatients with DHF increased significantly from 31.7% in 2006 to 34.4% in 2008 (p = 0.008); 68 DHF cases were managed safely on an outpatient basis after compared with none before implementation. DHF inpatients had more serious signs such as clinical fluid accumulation (15.5% vs 2.9% of outpatients), while most DHF outpatients had hypoproteinemia (92.7% vs 81.3% of inpatients). The eight intensive care unit admissions and five deaths during this time period all occurred among inpatients. The new criteria resulted in a median cost saving of US$1.4 million to patients in 2008. Conclusion The new dengue admission criteria were effective in sustainably reducing length of hospitalization, yielding considerable cost savings. A minority of DHF patients with mild symptoms recovered uneventfully through outpatient management. |
| Databáze: | OpenAIRE |
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