Abstract
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 services
3. Pleural effusion (CXRs with effusions, subsequently proven to be tuberculous)
4. CXRs with concurrent pathologies
5. Lost to follow up
Results: 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.
- © 2011 ERS
