Srivathsan Thiruvengadam1, Lauren Giudicatti2, Siaavash Maghami2, Hussein Farah3, Justin Waring4, Grant Waterer5, Kumaraweerage Ruad Herman Perera6. 1. Department of Clinical Services, Royal Perth Hospital, Australia. Electronic address: srivathsan.thiruvengadam@health.wa.gov.au. 2. Department of Clinical Services, Royal Perth Hospital, Australia. 3. Western Australia Tuberculosis Control Program, Anita Clayton Centre, Department of Health, Government of Western Australia, Australia. 4. Department of Respiratory Medicine, Royal Perth Hospital and PathWest Laboratory Medicine, Australia; Western Australia Tuberculosis Control Program, Anita Clayton Centre, Department of Health, Government of Western Australia, Australia. 5. Department of Respiratory Medicine, Royal Perth Hospital and PathWest Laboratory Medicine, Australia; School of Medicine and Pharmacology, University of Western Australia, Australia. 6. Department of Respiratory Medicine, Royal Perth Hospital and PathWest Laboratory Medicine, Australia; Western Australia Tuberculosis Control Program, Anita Clayton Centre, Department of Health, Government of Western Australia, Australia; School of Medicine and Pharmacology, University of Western Australia, Australia.
Abstract
BACKGROUND: Inadequate isolation of patients with active pulmonary tuberculosis causes exposure whereas over-cautious isolation generates time and cost inefficiencies. This study aims to ascertain the delays involved in isolating subjects and the importance of risk factors. METHODS AND MATERIAL: Between December 2010 and January 2013, a retrospective analysis of 271 subjects was performed. Information was obtained from discharge letters, radiological and microbiological results. RESULTS: The median time taken to isolate subjects was 0 days, and 71.7% were isolated within 1 day. Most subjects (75.3%) had sputum samples obtained after isolation, of which 14.7% were positive. The median time from admission to first sputum sample was 1 day. Smear was negative in 174 subjects (85.3%). Country of birth (high or low risk) did not significantly affect sputum positivity (25.5% vs 19.4%, p=0.52). Suspicious radiological findings were noted in 38.6% subjects, and 32.8% had a suspicious clinical history. Subjects with both clinical and radiological probability had more sputum positivity (46.2%), compared to subjects who had neither (2.7%). CONCLUSION: There are delays with isolation and diagnosis of subjects with a high probability of tuberculosis. Clinical and radiological probability were more significant in predicting sputum positivity than country of birth. Crown
BACKGROUND: Inadequate isolation of patients with active pulmonary tuberculosis causes exposure whereas over-cautious isolation generates time and cost inefficiencies. This study aims to ascertain the delays involved in isolating subjects and the importance of risk factors. METHODS AND MATERIAL: Between December 2010 and January 2013, a retrospective analysis of 271 subjects was performed. Information was obtained from discharge letters, radiological and microbiological results. RESULTS: The median time taken to isolate subjects was 0 days, and 71.7% were isolated within 1 day. Most subjects (75.3%) had sputum samples obtained after isolation, of which 14.7% were positive. The median time from admission to first sputum sample was 1 day. Smear was negative in 174 subjects (85.3%). Country of birth (high or low risk) did not significantly affect sputum positivity (25.5% vs 19.4%, p=0.52). Suspicious radiological findings were noted in 38.6% subjects, and 32.8% had a suspicious clinical history. Subjects with both clinical and radiological probability had more sputum positivity (46.2%), compared to subjects who had neither (2.7%). CONCLUSION: There are delays with isolation and diagnosis of subjects with a high probability of tuberculosis. Clinical and radiological probability were more significant in predicting sputum positivity than country of birth. Crown