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One-Year Outcomes and Health Care Utilization in Survivors of Severe Acute Respiratory Syndrome
Catherine M. Tansey, MSc;
Marie Louie, MD;
Mark Loeb, MD;
Wayne L. Gold, MD;
Matthew P. Muller, MD;
JoAnne de Jager, BSc(N);
Jill I. Cameron, PhD;
George Tomlinson, PhD;
Tony Mazzulli, MD;
Sharon L. Walmsley, MD;
Anita R. Rachlis, MD;
Barbara D. Mederski, MD;
Mike Silverman, MD;
Zev Shainhouse, MD;
Issa E. Ephtimios, MD;
Monica Avendano, MD;
James Downey, MD, PhD;
Rima Styra, MD;
Deborah Yamamura, MD;
Marvin Gerson, MD;
Matthew B. Stanbrook, MD, PhD;
Theodore K. Marras, MD, MSc;
Elizabeth J. Phillips, MD;
Noë Zamel, MD;
Susan E. Richardson, MD;
Arthur S. Slutsky, MD;
Margaret S. Herridge, MD, MPH
Arch Intern Med. 2007;167(12):1312-1320.
Background Severe Acute Respiratory Syndrome (SARS) became a global epidemic in 2003. Comprehensive information on 1-year outcomes and health care utilization is lacking. Research conducted during the SARS outbreak may help inform research planning for future public health emergencies. The objective of this study was to evaluate the 1-year outcomes in survivors of SARS and their family caregivers.
Method The study was prospective and observational. We evaluated 117 SARS survivors from Toronto, Ontario. Patients were interviewed and underwent physical examination, pulmonary function testing, chest radiography, a 6-minute-walk test, quality-of-life measures, and self-report of health care utilization. At 1 year, informal caregivers were identified for a survey on caregiver burden.
Results The enrolled survivors of SARS were young (median age, 42 years), and most were women (67%) and health care workers (65%). At 1 year after hospital discharge, pulmonary function measures were in the normal range, but 18% of patients had a significant reduction in distance walked in 6 minutes. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) domains were 0.3 to 1.0 SD below normal at 1 year. Of the patients, 17% had not returned to work by 1 year. Fifty-one patients required 668 visits to psychiatry or psychology practitioners. During the SARS epidemic, informal caregivers reported a decline of 1.6 SD below normal on the mental component score of the SF-36.
Conclusions Most SARS survivors had good physical recovery from their illness, but some patients and their caregivers reported a significant reduction in mental health 1 year later. Strategies to ameliorate the psychological burden of an epidemic on the patient and family caregiver should be considered as part of future pandemic planning.
Author Affiliations: Department of Medicine, University Health Network, Toronto, Ontario (Ms Tansey and Drs Gold, Tomlinson, Walmsley, Styra, Stanbrook, Marras, Zamel, and Herridge); Departments of Microbiology (Drs Louie and Phillips) and Medicine (Dr Rachlis), Sunnybrook Health Sciences Centre, Toronto; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario (Dr Loeb); Departments of Medicine (Dr Muller) and Microbiology (Dr Mazzulli), Mount Sinai Hospital, Toronto; Division of Microbiology, Sick Children's Hospital, Toronto (Ms de Jager and Dr Richardson); Toronto Rehabilitation Institute, Toronto (Dr Cameron); Department of Medicine, North York General Hospital, North York, Ontario (Dr Mederski); Department of Medicine, Rouge Valley Health Centre, Ajax, Ontario (Dr Silverman); Department of Medicine, The Scarborough Hospital, Scarborough, Ontario (Dr Shainhouse); Departments of Medicine, Markham-Stouffville Hospital, Markham, Ontario, and Southlake Regional Health Centre, Newmarket, Ontario (Dr Ephtimios); Department of Respirology, West Park Health Care Centre, Toronto (Dr Avendano); Department of Medicine, Toronto East General, East York, Ontario (Dr Downey); Department of Medicine, William Osler Health Centre, Etobicoke, Ontario (Dr Yamamura); Department of Medicine, Humber River Regional Hospital, Toronto (Dr Gerson); Departments of Medicine and Critical Care Medicine, St Michael's Hospital, Toronto (Dr Slutsky); and the Institute of Medical Sciences (Ms Tansey and Drs Slutsky and Herridge), Interdepartmental Division of Critical Care Medicine (Drs Slutsky and Herridge), and the Department of Health Policy and Management Evaluation (Dr Tomlinson), University of Toronto. Dr Louie is now with the Provincial Laboratory for Public Health (Microbiology) and the University of Calgary, Calgary, Alberta. Ms de Jager and Dr Yamamura are now with the Department of Pathology and Molecular Medicine, McMaster University. Dr Cameron is now with the Department of Occupational Science and Occupational Therapy, University of Toronto. Dr Ephtimios is now only with the Department of Medicine, Markham-Stouffville Hospital. Dr Phillips is now with the Department of Clinical Pharmacology, University of British Columbia, Vancouver. Dr Slutsky is now with the Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital.
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