Back to Search
Start Over
Patient pathway analysis of tuberculosis diagnostic delay: a multicentre retrospective cohort study in China
- Source :
- Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 27(7)
- Publication Year :
- 2020
-
Abstract
- Objectives Delay in diagnosis of tuberculosis (TB) is an important but under-appreciated problem. Our study aimed to analyse the patient pathway and possible risk factors of long diagnostic delay (LDD). Methods We enrolled 400 new bacteriologically diagnosed patients with pulmonary TB from 20 hospitals across China. LDD was defined as an interval between the initial care visit and the confirmation of diagnosis exceeding 14 days. Its potential risk factors were investigated by multivariate logistic regression and multilevel logistic regression. Hospitals in China were classified by increasing size, from level 0 to level 3. TB laboratory equipment in hospitals was also evaluated. Results The median diagnostic delay was 20 days (IQR: 7–72 days), and 229 of 400 patients (57.3%, 95%CI 52.4–62.1) had LDD; 15% of participants were diagnosed at the initial care visit. Compared to level 0 facilities, choosing level 2 (OR 0.27, 95%CI 0.12–0.62, p 0.002) and level 3 facilities (OR 0.34, 95%CI 0.14–0.84, p 0.019) for the initial care visit was independently associated with shorter LDD. Equipping with smear, culture, and Xpert at initial care visit simultaneously also helped to avoid LDD (OR 0.28, 95%CI 0.09–0.82, p 0.020). The multilevel logistic regression yielded similar results. Availability of smear, culture, and Xpert was lower in level 0–1 facilities than in level 2–3 facilities (p Conclusions Most patients failed to be diagnosed at the initial care visit. Patients who went to low-level facilities initially had a higher risk of LDD. Improvement of TB laboratory equipment, especially at low-level facilities, is urgently needed.
- Subjects :
- 0301 basic medicine
Microbiology (medical)
Adult
Male
medicine.medical_specialty
China
Tuberculosis
Delayed Diagnosis
Adolescent
030106 microbiology
Logistic regression
Patient pathway
03 medical and health sciences
Young Adult
0302 clinical medicine
Risk Factors
Internal medicine
medicine
Humans
030212 general & internal medicine
Aged
Retrospective Studies
Aged, 80 and over
Bacteriological Techniques
Potential risk
business.industry
Retrospective cohort study
General Medicine
Mycobacterium tuberculosis
Middle Aged
medicine.disease
Hospitals
Multilevel logistic regression
Infectious Diseases
Female
Pulmonary tb
business
Subjects
Details
- ISSN :
- 14690691
- Volume :
- 27
- Issue :
- 7
- Database :
- OpenAIRE
- Journal :
- Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
- Accession number :
- edsair.doi.dedup.....cbbbb6497d553b23bc483d674c22d9e9