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首页> 外文期刊>BMC Infectious Diseases >Delayed diagnosis and associated factors among new pulmonary tuberculosis patients diagnosed at the emergency department of a tertiary care hospital in Porto Alegre, South Brazil: a prospective patient recruitment study
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Delayed diagnosis and associated factors among new pulmonary tuberculosis patients diagnosed at the emergency department of a tertiary care hospital in Porto Alegre, South Brazil: a prospective patient recruitment study

机译：在巴西南部阿雷格里港三级医院急诊科诊断的新肺结核患者中，延迟诊断和相关因素：一项前瞻性患者招募研究

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Background Control of tuberculosis (TB) depends on early diagnosis and treatment at the primary health care level. However, many patients are still diagnosed late with TB at hospitals. The present study aimed to investigate the delay in diagnosis of TB patients at the emergency department. Methods This was a prospective study in a general, tertiary care, university-affiliated hospital of a city with a high prevalence of TB in Brazil. New TB patients?≥?14?years diagnosed with pulmonary TB at the emergency department of Hospital de Clínicas de Porto Alegre were prospectively recruited between February 2010 and January 2012. The consenting patients meeting our inclusion criteria were interviewed using a pre-tested questionnaire. We evaluated the delay in time until diagnosis and identified factors associated with delayed diagnosis (patient and health care system delays). Results We included 153 patients. The median total time of delay, patient delay, and health care system delay were 60 (interquartile range [IQR]: 30–90.5?days), 30 (lQR: 7–60?days), and 18 (IQR: 9–39.5?days) days, respectively. The factors that were independently associated with patient delay (time?≥?30?days) were crack (odds ratio [OR]?=?4.88, p?=?0.043) and cocaine (OR?=?6.68, p?=?0.011) use. The factors that were independently associated with health care system delay (time?≥?18?days) were weight loss (OR?=?2.76, p?=?0.025), miliary pattern (OR?=?5.33, p?=?0.032), and fibrotic changes (OR?=?0.12, p?=?0.013) on chest X-ray. Conclusions Patient delay appears to be the main problem in this city with a high prevalence of TB in Brazil. The main factor associated with patient delay is drug abuse (crack and cocaine). Our study shows substance abuse programs need to be aware of control of TB, with health interventions focusing on TB education programs.
机译：结核病的背景控制取决于初级卫生保健水平的早期诊断和治疗。但是，仍有许多患者在医院被诊断出结核病晚期。本研究旨在调查急诊科对结核病患者诊断的延迟。方法这是在巴西结核病高发城市的一家普通的三级护理大学附属医院中进行的一项前瞻性研究。在2010年2月至2012年1月之间，预先招募了在阿雷格里港医院急诊科诊断为肺结核的≥14岁的新结核病患者。对符合我们纳入标准的同意患者进行了预先测试的问卷调查。我们评估了直到诊断的时间延迟，并确定了与延迟诊断（患者和医疗系统延迟）相关的因素。结果我们纳入了153例患者。延迟，患者延迟和卫生保健系统延迟的总时间中位数分别为60（四分位间距[IQR]：30–90.5？days），30（lQR：7–60？days）和18（IQR：9–39.5）天）分别。与患者延误（时间≥30天）独立相关的因素包括裂纹（比值比[OR]≥4.88，p≥0.043）和可卡因（OR≥6.68，p≥0.643）。 0.011）使用。与医疗保健系统延误（时间≥18天）独立相关的因素有体重减轻（OR = 2.76，p = 0.025），粟粒型（OR = 5.33，p = 5.33）。 0.032）和胸部X线检查的纤维化变化（OR？=？0.12，p？=？0.013）。结论在巴西结核病高发的这座城市，患者延误似乎是主要问题。与患者延迟相关的主要因素是药物滥用（裂纹和可卡因）。我们的研究表明，药物滥用计划需要意识到结核病的控制，而健康干预措施应侧重于结核病教育计划。

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