Evaluation of prediagnosis emergency department presentations in patients with active tuberculosis

the role of chest radiography, risk factors and symptoms

S. C. Appleton, D. W. Connell, A. Singanayagam, P. Bradley, D. Pan, F. Sanderson, B. Cleaver, A. Rahman, O. M. Kon (Lead / Corresponding author)

    Research output: Contribution to journalArticle

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    Abstract

    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.

    Original languageEnglish
    Article numbere000154
    Pages (from-to)1-8
    Number of pages8
    JournalBMJ Open Respiratory Research
    Volume4
    Issue number1
    DOIs
    Publication statusPublished - 17 Jan 2017

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    Radiography
    Hospital Emergency Service
    Tuberculosis
    Thorax
    Chronic Disease Hospitals
    Hospital Records
    Sweat
    Urban Hospitals
    Pulmonary Tuberculosis
    Cough
    Weight Loss
    Early Diagnosis
    Cohort Studies
    Fever
    Retrospective Studies
    Alcohols
    Lung
    Population

    Cite this

    @article{84124df85c6b4654ba8b4335b591be0d,
    title = "Evaluation of prediagnosis emergency department presentations in patients with active tuberculosis: the role of chest radiography, risk factors and symptoms",
    abstract = "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.",
    author = "Appleton, {S. C.} and Connell, {D. W.} and A. Singanayagam and P. Bradley and D. Pan and F. Sanderson and B. Cleaver and A. Rahman and Kon, {O. M.}",
    year = "2017",
    month = "1",
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    language = "English",
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    Evaluation of prediagnosis emergency department presentations in patients with active tuberculosis : the role of chest radiography, risk factors and symptoms. / Appleton, S. C.; Connell, D. W.; Singanayagam, A.; Bradley, P.; Pan, D.; Sanderson, F.; Cleaver, B.; Rahman, A.; Kon, O. M. (Lead / Corresponding author).

    In: BMJ Open Respiratory Research, Vol. 4, No. 1, e000154, 17.01.2017, p. 1-8.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Evaluation of prediagnosis emergency department presentations in patients with active tuberculosis

    T2 - the role of chest radiography, risk factors and symptoms

    AU - Appleton, S. C.

    AU - Connell, D. W.

    AU - Singanayagam, A.

    AU - Bradley, P.

    AU - Pan, D.

    AU - Sanderson, F.

    AU - Cleaver, B.

    AU - Rahman, A.

    AU - Kon, O. M.

    PY - 2017/1/17

    Y1 - 2017/1/17

    N2 - 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.

    AB - 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.

    U2 - 10.1136/bmjresp-2016-000154

    DO - 10.1136/bmjresp-2016-000154

    M3 - Article

    VL - 4

    SP - 1

    EP - 8

    JO - BMJ Open Respiratory Research

    JF - BMJ Open Respiratory Research

    SN - 2052-4439

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    ER -