TY - JOUR T1 - Delays in the diagnosis and treatment of tuberculosis in a south London hospital: The role of chest X-rays JF - European Respiratory Journal JO - Eur Respir J VL - 38 IS - Suppl 55 SP - p4389 AU - Elena Karampini AU - Deepak S. Rao AU - Shahed Islam AU - Lucinda Dawson AU - Bassey Asuquo AU - Thomas C. Stokes Y1 - 2011/09/01 UR - http://erj.ersjournals.com/content/38/Suppl_55/p4389.abstract N2 - Introduction: Early referral of patients with suspected tuberculosis (TB) has a significant impact to clinical outcomes, leading to shorter infectivity times and reduced morbidity and mortality rates.Aim: To identify factors contributing to delays in the diagnosis of intra-thoracic (pulmonary, mediastinal and pleural) TB.Methods: A retrospective case review of all patients who were diagnosed with intra-thoracic TB (January 2003 to January 2011) in Queen Elizabeth Hospital, Woolwich. Allowing for a chest X-ray (CXR) turn-around time of 3 weeks and a median period of 7 days between TB diagnosis and commencing treatment, we reviewed the full radiological history of all patients for whom the cut-off period of 28 days was exceeded. Delayed cases were divided into five groups, according to the reason for the delay:1. Clinical diagnostic delay (unreported/misreported CXRs)2. Delayed referral to specialist services3. Pleural effusion (CXRs with effusions, subsequently proven to be tuberculous)4. CXRs with concurrent pathologies5. Lost to follow upResults: 634 intra-thoracic TB notifications were made within the specified time period. 121 patients (19%) had at least one abnormal CXR taken 28 or more days prior to starting treatment (group 1: 38, group 2: 43, group 3: 16, group 4: 8, group 5: 16). The time delay between first abnormal CXR and starting treatment varied considerably (median: 69.5 days, range: 29–1020 days) and was greater in male (73%) and Asian patients (40%). 32 patients (26.4%) were sputum smear positive.Conclusion: The diagnosis of RTB is delayed for a significant number of patients and appropriate measures should be taken in order to minimise such delays. ER -