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


CONCLUSIONS
Older age and chronic renal insufficiency are risk factors for delayed TB while in the ED. Typical symptoms should heighten alertness for recognizing TB.
Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung County, Taiwan.
Yung-Lin
YL
Yen
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.
I-Chuan
IC
Chen
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.
Chien-Hung
CH
Wu
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.
Wen-Cheng
WC
Li
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.
Cheng-Hsien
CH
Wang
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.
Tsung-Cheng
TC
Tsai
D000368:Aged; D000369:Aged, 80 and over; D057210:Delayed Diagnosis; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*
Delayed recognition; Emergency department; Pulmonary tuberculosis; Tuberculosis