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ARTICLE

Delays in the Suspicion and Treatment of Tuberculosis among Hospitalized Patients

Venkatarama K. Rao, MD, PhD; Elizabeth P. Iademarco, RN, MPH; Victoria J. Fraser, MD; and Marin H. Kollef, MD

2 March 1999 | Volume 130 Issue 5 | Pages 404-411

Background: Despite increased awareness of tuberculosis, delays in management are common.

Objective: To investigate management delays among hospitalized patients with tuberculosis.

Design: Retrospective cohort study.

Setting: The Barnes-Jewish-Christian Health System, a network of eight community and tertiary-care facilities serving the St. Louis, Missouri, metropolitan area.

Patients: All 203 patients with tuberculosis hospitalized in the Barnes-Jewish-Christian Health System from 1988 to 1996.

Measurements: Time from admission to first consideration of the diagnosis (suspicion interval), first consideration and treatment initiation (treatment interval), and admission and treatment initiation (overall management interval) were determined. Delays were defined as intervals longer than 24 hours.

Results: The overall management interval (median, 6 days [5th and 95th percentiles, 1 and 52 days]) exceeded 24 hours in 152 patients (74.9% [95% CI, 68.9% to 80.9%]). The suspicion interval (median, 1 day [5th and 95th percentiles, 0 and 16 days]) exceeded 24 hours in 54 patients (26.6% [CI, 20.5% to 32.7%]), and the treatment interval (median, 3 days [5th and 95th percentiles, 0 and 51 days]) was prolonged in 130 patients (64.0% [CI, 57.4% to 70.6%]). Overall management delays of more than 10 and 25 days occurred in 33.5% (CI, 27.0% to 40.0%) and 18.7% (CI, 13.3% to 24.1%) of patients, respectively. The 55 patients with smears that were positive for acid-fast bacilli had a median treatment interval of 3 days (5th and 95th percentiles, 0 and 33 days); in 58.2% of patients (CI, 45.2% to 71.2%), this interval exceeded 24 hours.

Conclusions: Delays in initiation of treatment were more common than delays in the initial suspicion of tuberculosis. Both types of delays were common even in patients with disease that was confirmed by a positive smear. These data illustrate a need for improved education of physicians about the benefits of early initiation of therapy for tuberculosis.

Author and Article Information

From Washington University School of Medicine, St. Louis, Missouri.

Acknowledgments: The authors thank Vic Tomlinson, MPA, Chief, State of Missouri Bureau of Tuberculosis Control and the staff of the state and local health departments of Missouri and Illinois for providing follow-up information.

Grant Support: In part by grant U50-CCU-710076-04 from the Centers for Disease Control and Prevention and the National Institute for Occupational Safety and Health.

Requests for Reprints: Marin H. Kollef, MD, Pulmonary and Critical Care Medicine, Washington University School of Medicine, Campus Box 8052, 660 South Euclid Avenue, St. Louis, MO 63110; e-mail, mkollef{at}pulmonary.wustl.edu.

Current Author Addresses: Dr. Rao: Division of Tuberculosis Control, State of Virginia Department of Health, 1500 East Main Street Station, Box 2448, Richmond, VA 23218-2448.

Ms. Iademarco and Dr. Kollef: Pulmonary and Critical Care Division, Washington University School of Medicine, Campus Box 8052, 660 South Euclid Avenue, St. Louis, MO 63110.

Dr. Fraser: Division of Infectious Diseases, Washington University School of Medicine, Campus Box 8051, 660 South Euclid Avenue, St. Louis, MO 63110.

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