Diagnostic evaluation of pulmonary tuberculosis: what do doctors of modern medicine do in India?
METHODS
Out- and in-patient services of the Department of Tuberculosis and Chest Diseases, King George's Medical College, Lucknow, India.


OBJECTIVE
To analyse diagnostic practices for pulmonary tuberculosis (PTB) among doctors of modern medicine and to estimate their association with diagnostic accuracy.


METHODS
A consecutive case series. The diagnostic practices of 518 doctors who had prescribed treatment for PTB to 270 patients were analysed.


RESULTS
Almost all of the doctors (99.8%, 95% CI 98.9-100.0) used chest X-ray, while 49.2% (95% CI 44.8-53.6) advised chest X-ray alone for diagnosis of PTB. On the other hand, 50.6% (95% CI 46.2-55.0) performed sputum microscopy while none used it without chest X-ray. Sputum microscopy was used three times more frequently by chest specialists compared with non-chest specialists (81.9% vs. 25.8%, P = 0.0000). Non-utilisation of sputum microscopy was associated with a significantly higher probability of prescribing anti-tuberculosis treatment for PTB in patients with non-tuberculous conditions (odds ratio 5.0; 95% CI 2.72-9.83).


CONCLUSIONS
Non-utilisation of sputum smear microscopy and continued reliance on chest X-ray only by up to 49% of practitioners of modern medicine might have serious public health implications. Strategies for their continued medical education and audit of their practices should be implemented without delay.
Prasad
R
R
Department of Tuberculosis and Chest Diseases, King George's Medical College, Lucknow, India. kgmcice@sancharnet.in
Nautiyal
R G
RG
Mukherji
P K
PK
Jain
A
A
Singh
K
K
Ahuja
R C
RC
D006801:Humans; D007194:India; D010818:Practice Patterns, Physicians'; D011859:Radiography; D013183:Sputum / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000000981:diagnostic imaging