Factors associated with delayed recognition of pulmonary tuberculosis in emergency departments in Taiwan

Yung-Lin Yen; I-Chuan Chen; Chien-Hung Wu; Wen-Cheng Li; Cheng-Hsien Wang; Tsung-Cheng Tsai

doi:10.1016/j.hrtlng.2015.03.004

Factors associated with delayed recognition of pulmonary tuberculosis in emergency departments in Taiwan

Heart Lung. 2015 Jul-Aug;44(4):353-9. doi: 10.1016/j.hrtlng.2015.03.004. Epub 2015 Apr 27.

Authors

Yung-Lin Yen¹, I-Chuan Chen², Chien-Hung Wu³, Wen-Cheng Li⁴, Cheng-Hsien Wang², Tsung-Cheng Tsai⁵

Affiliations

¹ Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung County, Taiwan.
² Department of Emergency Medicine, Chang Gung Memorial Hospital, No.6, W. Sec., Jiapu Rd., Puzih City, Chiayi County 613, Taiwan; Chang Gung University College of Medicine, No.5, Fusing St., Gueishan Township, Taoyuan County 333, Taiwan.
³ Chang Gung University College of Medicine, No.5, Fusing St., Gueishan Township, Taoyuan County 333, Taiwan; Department of Emergency Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City 833, Taiwan.
⁴ Chang Gung University College of Medicine, No.5, Fusing St., Gueishan Township, Taoyuan County 333, Taiwan; Department of Occupation Medicine, Chang-Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan.
⁵ Chang Gung University College of Medicine, No.5, Fusing St., Gueishan Township, Taoyuan County 333, Taiwan; Department of Emergency Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City 833, Taiwan. Electronic address: takk921@yahoo.com.tw.

PMID: 25929441
DOI: 10.1016/j.hrtlng.2015.03.004

Abstract

Objective: To identify and evaluate factors associated with delayed recognition of pulmonary tuberculosis (TB) in the emergency department (ED).

Background: Delayed recognition of pulmonary TB in ED may precipitate mortality and morbidity.

Methods: Medical records of newly diagnosed TB patients admitted to four hospitals in Taiwan were retrospectively reviewed. Patients were divided into two groups based on ED physicians' recognition or not of TB and statistically compared to identify differences in their characteristics.

Results: 310 newly diagnosed TB patients were identified; 150 were unrecognized in the ED. Cough, chest tightness, general malaise, and body weight loss were more common for those with recognized TB. Older age (≥65 yrs, P = 0.035) and chronic renal insufficiency (P = 0.005) were associated with delayed TB recognition.

Conclusion: Older age and chronic renal insufficiency are risk factors for delayed TB while in the ED. Typical symptoms should heighten alertness for recognizing TB.

Keywords: Delayed recognition; Emergency department; Pulmonary tuberculosis; Tuberculosis.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Delayed Diagnosis
Emergency Service, Hospital / standards*
Emergency Service, Hospital / statistics & numerical data
Female
Hospitalization / statistics & numerical data
Humans
Male
Middle Aged
Retrospective Studies
Risk Factors
Taiwan
Tuberculosis, Pulmonary / diagnosis*