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Evaluation of prediagnosis emergency department presentations in patients with active tuberculosis: the role of chest radiography, risk factors and symptoms
  1. S C Appleton1,
  2. D W Connell1,
  3. A Singanayagam1,
  4. P Bradley2,
  5. D Pan2,
  6. F Sanderson1,
  7. B Cleaver2,
  8. A Rahman2 and
  9. O M Kon1
  1. 1Tuberculosis Service, Imperial College Healthcare NHS Trust, London, UK
  2. 2Department of Emergency Medicine, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Professor O M Kon; onn.kon{at}imperial.nhs.uk

Abstract

Introduction London has a high rate of tuberculosis (TB) with 2572 cases reported in 2014. Cases are more common in non-UK born, alcohol-dependent or homeless patients. The emergency department (ED) presents an opportunity for the diagnosis of TB in these patient groups. This is the first study describing the clinico-radiological characteristics of such attendances in two urban UK hospitals for pulmonary TB (PTB) and extrapulmonary TB (EPTB).

Methods We conducted a retrospective cohort study using the London TB Register (LTBR) and hospital records to identify patients who presented to two London ED's in the 6 months prior to their ultimate TB diagnosis 2011–2012.

Results 397 TB cases were identified. 39% (154/397) had presented to the ED in the 6 months prior to diagnosis. In the study population, the presence of cough, weight loss, fever and night sweats only had prevalence rates of 40%, 34%, 34% and 21%, respectively. Chest radiography was performed in 76% (117/154) of patients. For cases where a new diagnosis of TB was suspected, 73% (41/56) had an abnormal radiograph, compared with 36% (35/98) of patients where it was not. There was an abnormality on a chest radiograph in 73% (55/75) of PTB cases and also in 40% (21/52) of EPTB cases where a film was requested.

Conclusions A large proportion of patients with TB present to ED. A diagnosis was more likely in the presence of an abnormal radiograph, suggesting opportunities for earlier diagnosis if risk factors, symptoms and chest radiograph findings are combined.

  • Infection Control
  • Tuberculosis

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Contributors OMK, SCA and DWC devised the study and SCA, PB and DP performed the data collection. SCA and PB performed the data analysis. SCA, DWC, AS, PB, DP, BC and OMK contributed to data interpretation. SA wrote the manuscript with assistance from DC, OMK and AS. All authors contributed to the review and editing of the manuscript.

  • Funding The research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests AS has received honoraria for speaking from GlaxoSmithKline.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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