title: Evaluation of prediagnosis emergency department presentations in patients with active tuberculosis: the role of chest radiography, risk factors and symptoms.
abstract: BACKGROUND
  London has a high rate of tuberculosis (TB) with 2572 cases reported in 2014. Cases are more common in non-UK born, alcohol-dependent or homeless patients. The emergency department (ED) presents an opportunity for the diagnosis of TB in these patient groups. This is the first study describing the clinico-radiological characteristics of such attendances in two urban UK hospitals for pulmonary TB (PTB) and extrapulmonary TB (EPTB).
  
  
  METHODS
  We conducted a retrospective cohort study using the London TB Register (LTBR) and hospital records to identify patients who presented to two London ED's in the 6 months prior to their ultimate TB diagnosis 2011-2012.
  
  
  RESULTS
  397 TB cases were identified. 39% (154/397) had presented to the ED in the 6 months prior to diagnosis. In the study population, the presence of cough, weight loss, fever and night sweats only had prevalence rates of 40%, 34%, 34% and 21%, respectively. Chest radiography was performed in 76% (117/154) of patients. For cases where a new diagnosis of TB was suspected, 73% (41/56) had an abnormal radiograph, compared with 36% (35/98) of patients where it was not. There was an abnormality on a chest radiograph in 73% (55/75) of PTB cases and also in 40% (21/52) of EPTB cases where a film was requested.
  
  
  CONCLUSIONS
  A large proportion of patients with TB present to ED. A diagnosis was more likely in the presence of an abnormal radiograph, suggesting opportunities for earlier diagnosis if risk factors, symptoms and chest radiograph findings are combined.
authors.affiliation: Tuberculosis Service , Imperial College Healthcare NHS Trust , London , UK.
authors.forename: S C
authors.initials: SC
authors.lastname: Appleton
authors.affiliation: Tuberculosis Service , Imperial College Healthcare NHS Trust , London , UK.
authors.forename: D W
authors.initials: DW
authors.lastname: Connell
authors.affiliation: Tuberculosis Service , Imperial College Healthcare NHS Trust , London , UK.
authors.forename: A
authors.initials: A
authors.lastname: Singanayagam
authors.affiliation: Department of Emergency Medicine , Imperial College Healthcare NHS Trust , London , UK.
authors.forename: P
authors.initials: P
authors.lastname: Bradley
authors.affiliation: Department of Emergency Medicine , Imperial College Healthcare NHS Trust , London , UK.
authors.forename: D
authors.initials: D
authors.lastname: Pan
authors.affiliation: Tuberculosis Service , Imperial College Healthcare NHS Trust , London , UK.
authors.forename: F
authors.initials: F
authors.lastname: Sanderson
authors.affiliation: Department of Emergency Medicine , Imperial College Healthcare NHS Trust , London , UK.
authors.forename: B
authors.initials: B
authors.lastname: Cleaver
authors.affiliation: Department of Emergency Medicine , Imperial College Healthcare NHS Trust , London , UK.
authors.forename: A
authors.initials: A
authors.lastname: Rahman
authors.affiliation: Tuberculosis Service , Imperial College Healthcare NHS Trust , London , UK.
authors.forename: O M
authors.initials: OM
authors.lastname: Kon
keywords: Infection Control; Tuberculosis