title: The emergency department is a determinant point of contact of tuberculosis patients prior to diagnosis.
abstract: METHODS
  Metropolitan Edmonton, Canada.
  
  
  OBJECTIVE
  To determine 1) the pre-diagnosis emergency department utilization history of urban tuberculosis patients, and 2) the resource and outcome implications of emergency department utilization by tuberculosis patients pre-diagnosis.
  
  
  METHODS
  Nested case (emergency department attendee) control (non-emergency department attendee) study of a retrospective cohort of tuberculosis patients.
  
  
  METHODS
  All tuberculosis notifications, 1994 through 1998.
  
  
  METHODS
  Emergency department utilization during the 6 months antedating the diagnosis and emergency department attendee characteristics; for those notified in 1997 and 1998, hospitalizations, nosocomial infectiousness time, and health care costs.
  
  
  RESULTS
  Of 250 cases of tuberculosis, 117 (47%) made a total of 258 pre-diagnosis emergency department visits. Emergency department use increased the nearer the patient was to diagnosis. Emergency department attendees were more likely to be older, to have smear and/or culture positive respiratory disease, to have a risk factor for progression of infection to disease, and to have a fatal outcome. In 1997 and 1998, emergency department throughput accounted for 70% of all hospitalization days, 95% of all source case nosocomial infectiousness time, and most health care costs of tuberculosis patients pre-diagnosis.
  
  
  CONCLUSIONS
  The emergency department is heavily utilized by urban tuberculosis patients pre-diagnosis. Emergency department throughput of tuberculosis patients pre-diagnosis has major resource and outcome implications. The emergency department may present an opportunity for earlier diagnosis.
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Canada. richard.long@ualberta.ca
authors.forename: R
authors.initials: R
authors.lastname: Long
authors.forename: M
authors.initials: M
authors.lastname: Zielinski
authors.forename: D
authors.initials: D
authors.lastname: Kunimoto
authors.forename: J
authors.initials: J
authors.lastname: Manfreda
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006295:Health Resources; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D014505:Urban Population