关键词: 结核,肺, 学生, 公共卫生, 提醒者系统, 病人识别系统

Abstract:

Objective: To analyze the application effect of single case early warning of pulmonary tuberculosis in schools in Zhejiang Province in the automatic early warning system for infectious diseases (referred to as the “early warning system”). Methods: The case information of school pulmonary tuberculosis cases from July 6, 2018 to December 31, 2022 was collected from the early warning information of tuberculosis generated by the automatic early warning system of infectious diseases in Zhejiang Province (including the number of warning signals, signal response time, and response results, etc), and the report management system of infectious diseases in the same period. Using February 24, 2021 as the cut-off point, compare the warning effect of the warning system before and after the adjustment of the warning object. Results: From July 6, 2018 to December 31, 2022, a total of 35418 school pulmonary tuberculosis warning signals were issued by the provincial early warning system. The top three cities with the highest number of signals were Ningbo (7531, 21.26%), Wenzhou (6786, 19.16%) and Hangzhou (5344, 15.09%). The early warning signal response rate was 100.00%, the timely response rate was 97.60% (34567/35418), and the median response time (quartile)(M(Q₁,Q₃)) was 1.19 (0.30, 5.83) h. Among them, 5498 (15.52%) signals were initially judged as suspicious signals. After on-site investigation and verification, 4714 cases of school pulmonary tuberculosis were in line with the early warning target, and the positive predictive value of early warning signals was 13.31% (4714/35418). After adjusting the warning objects, the number of daily warning signals decreased by -60.24% ((11.43-28.75)/28.75), and the suspected signal rate increased by 25.29% ((18.43-14.71)/14.71). The suspected signal rate of different diagnostic results (18.43% (1424/7728)) was significantly higher than before adjustment (14.71% (4074/27690)), and the difference was statistically significant (χ²=63.256, P=0.000), of which, before and after adjustment, there was statistical difference in the suspected signal rate of early warning objects with etiological positive (17.94% (615/3429) and 20.91% (586/2803)) and no pathogen results (12.81% (2316/18086) and 14.80% (322/2175))(χ²=8.560,P=0.003; χ²=6.676,P=0.010). Conclusion: The automatic early warning of a single case of pulmonary tuberculosis in Zhejiang Province was operating well, which could preliminarily achieve the early warning of school pulmonary tuberculosis. By adjusting the warning objects, the application effect of early warning could be further improved.

Key words: Tuberculosis,pulmonary, Students, public health, Reminder systems, Patient identification systems