Effectiveness and Appropriateness of the LEPTO-SCORE for Decreasing Severity of Suspected Leptospirosis Cases Referred to Khon Kaen Hospital: A Stratified Randomized- controlled Field Trial in Khon Kaen (ประสิทธิผลและความเหมาะสมของปริมาณ LEPTO-SCORE )

The objective was to evaluate the effectiveness and appropriateness of LEPTO-SCORE for decreasing severity of suspected leptospirosis cases referred to treat in Khon Kaen Hospital. A stratified randomized-controlled field trial was conducted at 4 district hospitals in Khon Kaen province. The suspected leptospirosis patients admitted from July 2000 to February 2001 were included for study. The patients in an intervention group who had LEPTO-SCORE of at least 8 on admission or of at least 10 at 12 hour apart were assigned to refer to Khon Kaen Hospital. The severity of referred patients was assessed by using Modified APACHE II score at Khon Kaen Hospital (score of < 10 was accounted to be an appropriate refer). In all, 608 patients were recruited, 241(39.6%) in the intervention group and 367 (60.4%) in control group. Most patients were male (67.9%) with the mean age of 38 years and 86.7 percent were farmers. Twenty-nine patients were referred. The Modified APACHE II score of patients in the intervention group (7.5 ± 3.6) was lower than that of the control group (10 ± 5.3) without statistical difference (difference = 2.5, 95%CI: -1.9 to 6.4, p = 0.28). There was no significant difference of rate of appropriated refer between both groups (57% in intervention group, 50% in control group, p = 0.73). It was concluded that the LEPTO-SCORE tended to be useful for decreasing severity of suspected leptospirosis cases referred to treat in tertiary care center and for development of a proper referral system.