The Assessment Of Diagnosis And Treatment Of Hand,Foot And Mouth Disease(HFMD) Severe Cases

Background:The Ministry of Health of China published diagnostic and treatment program of hand, foot and mouth disese (HFMD) in2010based on previous program (2008edition) in order to regulate diagnosis and treatment of hand, foot and mouth disease. The World Health Organization also made corresponding guide of hand, foot and mouth disease on March2010. To understand implementation of treatment scheme and to master the current situation of diagnosis and treatment in our country, we carried out an investigation to assess the current situation of diagnosis and treatment of severe cases of HFMD in China.Objective:To understand the current situation of diagnosis and treatment of severe cases of HFMD in China and to further revise strategies of diagnosis and treatment of severe cases of HFMD is to provide the reference for disease burden of HFMD.Method:We choose the first5provinces (Henan, Shandong, Zhejiang, Sichuan and Yunnan) according to severe cases of HFMD and in which we choose15cities as investigation field. The cross-sectional study has carried among severe cases of HFMD.The investigated cases have chosen by systemetic sampling methodand the questionnaires have recorded by the field inquiring. The study includes the current situation of diagnosis and treatment of severe cases of HFMD, the useage of drug and mechanical ventilation.Results:1) The assessment of diagnosis:97%of cases accord with diagnostic criteria of severe cases according to the domestic clinical standard, but only3%of cases accord with diagnostic criteria of ordinary cases. According with the domestic diagnostic criteria,97.5%of cases were severe cases and only2.5%of cases were ordinary cases in laboratory identified cases. According to WHO standard,86%of cases accord with diagnostic criteria of severe cases and14%of cases accord with diagnostic criteria of ordinary disease cases. Among the confirmed cases with EV71 infection, the91%of cases accord with complications diagnosis standard and9%of cases accord with diagnostic criteria of ordinary disease cases. The consistency of domestic guide and WHO recommend guide shows:the consistency of two standard is weak (Kappa coefficient is0.027).2) the assessment of the main drug:the drugs utilization rate of the ordinary cases and severe cases according with domestic standard:the utilization rate of glucocorticoid were90%and95%respectively, antiviral agents were90%and77%respectively, antibiotics were80%and87%respectively, the immune agents were75%and63%respectively, antifebrile analgesic drugs were45%, blood vessels active drug were15%and17%, and the utilization rates of two kinds of drugs of cases have no statistical difference.Dehydration antihypertensive drugs were70%and92%respectively (P=0.001), the Chinese medicine were55%and78%respectively (P=0.01), the sedative were5%and25%respectively (P=0.04), and the utilization rates of drugs of two kinds of cases have statistical significance.3) the assessment of mechanical ventilation:the ordinary cases did not use mechanical ventilation and the rate of mechanical ventilation of severe cases was21%. According to WHO guide,1.4%of the ordinary cases implement mechanical ventilation,2.7%of the cases involved nervous system implement mechanical ventilation,29%of the cases of early cardiopulmonary collapse implement mechanical ventilation, and83%of the cases of late cardiopulmonary collapse cases implement mechanical ventilation.Conclusion:1) The most of severe cases of HFMD accord with diagnostic criteria of domestic or WHO criteria.2) The consistency of domestic and WHO recommend guide is weak.3) Before admitting to the hospitals the main drugs were antibiotics, antiviral agents, the chinese medicine and in the hospital the main drugs were glucocorticoid, dehydrated agents, antibiotics, antiviral drugs and the chinese medicine. The proportion of antifebrile analgesic drugs, antifebrile analgesic drugs and the blood vessel active drug is not high according to domestic and WHO guide.4) The utilization rate of mechanical ventilation is not high according to the domestic and WHO guide.