During the study period, 132 relevant patient admissions were identified, 71 (54%) in the teaching hospital and 61 in the district general hospital. Fifty-six (42.4%) patients were male and the median age was 46 years (range 16–97). As many as 39 (29.6%) patients had been referred by a general practitioner, 87 (65.9%) had been admitted through A&E, 3 (2.3%) from other sources, and 3 (2.3%) had no route of referral documented.

A travel history was documented in the case notes of only 26/132 (19.7%) patients, 16 (62.5%) of whom had traveled abroad. Most patients were initially clerked by junior doctors ABT-888 research buy (foundation year 1, senior house officer, and registrar grades) and travel histories were recorded in 16/99 (16%) patients clerked

by a doctor below registrar grade compared to 7/25 (28%) at registrar (ST3) grade or more senior (p = 0.28) (Figure 1). The most common presenting complaints were diarrhea and/or vomiting in 71 patients (53.8%) and fever in 39 BMN 673 purchase patients (29.5%). Other presenting complaints were rashes in 13 (9.8%), jaundice in 19 (14.4%), and “unwell post-travel” in 5 (3.8%) patients. Travel histories were poorly recorded, irrespective of the nature of the presenting complaint (Figure 2). Two patients had delay in diagnosis of a travel-related illness because no initial travel history was taken. Both were treated successfully. For the 16 patients who had traveled abroad, the destination was recorded in 14 (87.5%), a reason for travel in 12 (75%), and the interval between travel and presentation in 12 (75%) (all within 1 y). A sexual history was only recorded for four (25.0%) and location Megestrol Acetate within destination country in three (18.8%). Questions about pretravel health advice were only recorded

for one patient (6.3%). Duration of travel was recorded in eight patients (50.0%). Of the five patients presenting with fever after travel, none had adequate documentation of a viral hemorrhagic fever risk assessment.9 Less than 20% of patients admitted into acute hospital settings with potentially relevant symptoms had any form of travel history documented. When histories were recorded, they were often insufficient to allow adequate patient and public health management. This has immediate implications for the patients involved and for the staff attending to them, and more wide-ranging public health implications due to the risk of missing significant communicable diseases. There are several British guidelines for the assessment and treatment of patients with travel-related infections including malaria,14 other infections,15 eosinophilia,16 and pandemic influenza,12 and concern continues about the rarer viral hemorrhagic fevers.17 These all require a travel history to be taken to identify patients at risk.