title: Tuberculosis in hospitalized patients: clinical characteristics of patients receiving treatment within the first 24 h after admission.
abstract: OBJECTIVE
  To evaluate clinical characteristics and outcomes in patients hospitalized for tuberculosis, comparing those in whom tuberculosis treatment was started within the first 24 h after admission with those who did not.
  
  
  METHODS
  This was a retrospective cohort study involving new tuberculosis cases in patients aged ≥ 18 years who were hospitalized after seeking treatment in the emergency room.
  
  
  RESULTS
  We included 305 hospitalized patients, of whom 67 (22.0%) received tuberculosis treatment within the first 24 h after admission ( ≤24h group) and 238 (88.0%) did not (>24h group). Initiation of tuberculosis treatment within the first 24 h after admission was associated with being female (OR = 1.99; 95% CI: 1.06-3.74; p = 0.032) and with an AFB-positive spontaneous sputum smear (OR = 4.19; 95% CI: 1.94-9.00; p < 0.001). In the ≤24h and >24h groups, respectively, the ICU admission rate was 22.4% and 15.5% (p = 0.258); mechanical ventilation was used in 22.4% and 13.9% (p = 0.133); in-hospital mortality was 22.4% and 14.7% (p = 0.189); and a cure was achieved in 44.8% and 52.5% (p = 0.326).
  
  
  CONCLUSIONS
  Although tuberculosis treatment was initiated promptly in a considerable proportion of the inpatients evaluated, the rates of in-hospital mortality, ICU admission, and mechanical ventilation use remained high. Strategies for the control of tuberculosis in primary care should consider that patients who seek medical attention at hospitals arrive too late and with advanced disease. It is therefore necessary to implement active surveillance measures in the community for earlier diagnosis and treatment.
authors.affiliation: Department of Pulmonology, Porto Alegre Hospital de Clínicas, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Denise Rossato
authors.initials: DR
authors.lastname: Silva
authors.affiliation: School of Nursing, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Larissa Pozzebon da
authors.initials: LP
authors.lastname: Silva
authors.affiliation: Department of Pulmonology, Porto Alegre Hospital de Clínicas, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Paulo de Tarso Roth
authors.initials: Pde T
authors.lastname: Dalcin
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000401:mortality*