title: One-year outcomes and health care utilization in survivors of severe acute respiratory syndrome.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Medicine, University Health Network, and Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Tansey
authors.forename: Marie
authors.initials: M
authors.lastname: Louie
authors.forename: Mark
authors.initials: M
authors.lastname: Loeb
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Gold
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Muller
authors.forename: JoAnne
authors.initials: J
authors.lastname: de Jager
authors.forename: Jill I
authors.initials: JI
authors.lastname: Cameron
authors.forename: George
authors.initials: G
authors.lastname: Tomlinson
authors.forename: Tony
authors.initials: T
authors.lastname: Mazzulli
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Walmsley
authors.forename: Anita R
authors.initials: AR
authors.lastname: Rachlis
authors.forename: Barbara D
authors.initials: BD
authors.lastname: Mederski
authors.forename: Mike
authors.initials: M
authors.lastname: Silverman
authors.forename: Zev
authors.initials: Z
authors.lastname: Shainhouse
authors.forename: Issa E
authors.initials: IE
authors.lastname: Ephtimios
authors.forename: Monica
authors.initials: M
authors.lastname: Avendano
authors.forename: James
authors.initials: J
authors.lastname: Downey
authors.forename: Rima
authors.initials: R
authors.lastname: Styra
authors.forename: Deborah
authors.initials: D
authors.lastname: Yamamura
authors.forename: Marvin
authors.initials: M
authors.lastname: Gerson
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Stanbrook
authors.forename: Theodore K
authors.initials: TK
authors.lastname: Marras
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Phillips
authors.forename: Noë
authors.initials: N
authors.lastname: Zamel
authors.forename: Susan E
authors.initials: SE
authors.lastname: Richardson
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Slutsky
authors.forename: Margaret S
authors.initials: MS
authors.lastname: Herridge
mesh_terms: D000328:Adult; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D004185:Disability Evaluation; D004196:Disease Outbreaks; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012129:Respiratory Function Tests; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology / Q000503:physiopathology / Q000534:rehabilitation*; D011795:Surveys and Questionnaires; D016138:Walking / Q000502:physiology