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Evaluation of prediagnosis emergency department presentations in patients with active tuberculosis: the role of chest radiography, risk factors and symptoms

机译：评估活动性肺结核患者急诊科急诊科的临床表现：胸片，危险因素和症状的作用

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Introduction 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.
机译：引言伦敦的结核病（TB）发病率很高，2014年报告了2572例。非英国出生，酒精依赖或无家可归的患者更常见。急诊科（ED）为这些患者组的结核病诊断提供了机会。这是首次描述英国两家城市医院的肺结核（PTB）和肺外结核（EPTB）出诊率的临床放射学特征。方法我们使用伦敦结核病登记簿（LTBR）和医院记录进行了一项回顾性队列研究，以鉴定在2011-2012年最终结核病诊断之前的6个月内曾到两个伦敦急诊科就诊的患者。结果鉴定出397 TB病例。在诊断前的6个月中，有39％（154/397）出现在急诊科。在研究人群中，咳嗽，体重减轻，发烧和盗汗的发生率分别仅为40％，34％，34％和21％。 76％（117/154）的患者进行了胸片检查。对于怀疑有新的结核病诊断的病例，有73％（41/56）的X线片检查不正常，而没有此病的患者为36％（35/98）。 73％（55/75）的PTB病例和40％（21/52）的EPTB病例需要摄影的胸部X光片均存在异常。结论很大一部分结核病患者出现ED。影像学检查异常时更有可能进行诊断，这表明如果将危险因素，症状和胸部影像学检查结果结合起来，可以进行早期诊断。

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