The emergency department is a determinant point of contact of tuberculosis patients prior to diagnosis
OBJECTIVES: To determine 1) the pre-diagnosis emergency department utilization history of urban tuberculosis patients, and 2) the resource and outcome implications of emergency department utilization by tuberculosis patients pre-diagnosis.
DESIGN: Nested case (emergency department attendee) control (non-emergency department attendee) study of a retrospective cohort of tuberculosis patients.
PATIENTS: All tuberculosis notifications, 1994 through 1998.
MAIN OUTCOME MEASURES: Emergency department utilization during the 6 months antedating the diagnosis and emergency department attendee characteristics; for those notified in 1997 and 1998, hospitalizations, nosocomial infectiousness time, and health care costs.
RESULTS: Of 250 cases of tuberculosis, 117 (47%) made a total of 258 pre-diagnosis emergency department visits. Emergency department use increased the nearer the patient was to diagnosis. Emergency department attendees were more likely to be older, to have smear and/or culture positive respiratory disease, to have a risk factor for progression of infection to disease, and to have a fatal outcome. In 1997 and 1998, emergency department throughput accounted for 70% of all hospitalization days, 95% of all source case nosocomial infectiousness time, and most health care costs of tuberculosis patients pre-diagnosis.
CONCLUSIONS: The emergency department is heavily utilized by urban tuberculosis patients pre-diagnosis. Emergency department throughput of tuberculosis patients pre-diagnosis has major resource and outcome implications. The emergency department may present an opportunity for earlier diagnosis.
Document Type: Regular Paper
Publication date: 2002-04-01
The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.
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