黃偉德
黃偉德

www.GentleMedicine.info

武肺是真,但「武肺死亡」卻不一定


Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy, Graziano Onder, MD, PhD; Giovanni Rezza, MD; Silvio Brusaferro, MD, JAMA. Published online March 23, 2020. doi:10.1001/jama.2020.4683

武漢肺炎是真的,但何謂「武漢肺炎死亡」,卻沒統一定義。

意大利的定義是:死者不論之前有何疾病,只要有RT-PCR病毒測試陽性,死因就會計入武肺的數。

結果是,意大利「武肺死者」中,其中一組病者的數字是:平均年齡79.5歲,25.1%有一種其他病,25.6%有兩種其他病,48.5% 有三種其他病,只有0.8%是沒有其他病。

第二,(先假設檢測方法皆為準確),但誰會得到檢測,視乎檢測設施是否足夠、檢測政策。意大利是,有嚴重病癥才做檢測,於是檢測得陽性者,可達19.3%,所以「個案死亡率」(case fatality) 會非常地高,達7.2%。 相對,韓國是即使輕症、無病癥也會檢測,個案死亡率只係 1.0%。

此所反映的,原來不一定某國的病例較嚴重,或是某個的防疫措施較強、醫療水平低高,而是根本沒統一的「誰得檢測」、「確診個案」、「武肺引致死亡」的定義。

Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy, Graziano Onder, MD, PhD; Giovanni Rezza, MD; Silvio Brusaferro, MD,

JAMA. Published online March 23, 2020. doi:10.1001/jama.2020.4683


// Case-fatality statistics in Italy are based on defining COVID-19–related deaths as those occurring in patients who test positive for SARS-CoV-2 via RT-PCR, independently from preexisting diseases that may have caused death. This method was selected because clear criteria for the definition of COVID-19–related deaths is not available.

Electing to define death from COVID-19 in this way may have resulted in an overestimation of the case-fatality rate.

COVID-19–related deaths are not clearly defined in the international reports available so far, and differences in definitions of what is or is not a COVID-19–related death might explain variation in case-fatality rates among different countries. //

https://jamanetwork.com/journals/jama/fullarticle/2763667

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