Where have you been? The potential to overlook imported disease in the acute setting

The incidence and prevalence of imported disease within the emergency department is not known. It is known, however, that a significant number of patients attend medical practitioners after they return from travelling. If practitioners working in emergency departments are unaware of the potential for nonendemic disease in the population of patients they attend, there is a possibility that imported diseases will remain undiagnosed in the acute setting.

The medical records of all patients attending a medium-sized accident and emergency department over the period of a week were reviewed to ascertain whether a travel history was recorded in patients who potentially have an imported disease, and whether imported diseases were considered in the differential diagnosis.

A travel history was recorded in only 2% of all patients attending the accident and emergency department (5.3% of those with a potential of having imported disease). This figure is unchanged if only patients with nontraumatic conditions are considered, or if those patients with low risk of imported disease are removed from the calculations.

It appears that medical practitioners in emergency departments do not routinely establish a travel history, or consider the diagnosis of imported disease, when presented with a clinical scenario that describes a possible imported disease. Consequently, there is a high potential for imported disease to be missed in the emergency department.