Delays in the diagnosis and treatment of hospitalized patients with smear-positive pulmonary tuberculosis

Abstract

The aim of present study was to investigate whether there was any delay in the diagnosis and treatment of inpatients with smear-positive pulmonary tuberculosis followed-up in our centre. We reviewed clinical records in February 1999 and identified 134 hospitalized patients with smear-positive pulmonary tuberculosis. Clinical files of the patients were analysed and a questionnaire was completed. Several intervals and delays were calculated. Median application interval was 17.5 days [95% confidence interval (CI) 21.3-32.4 days], median referral interval was 3.5 days (95% CI 6.8-11.4 days), median diagnosis interval was 3 days (95% CI 3.3-4.5 days) and median initiation of treatment interval was 1 day (95% CI 1.1-1.6 days). Patients delay was present in 28.4% of cases. The referral interval was longer than 2 days in 82 patients (institutional delay). Ninety-three patients (69.4%) had delays in the diagnosis and 34 patients (25.4%) had delays in the treatment. There was a doctor's delay in 119 of 134 patients (88.8%) and clinic's delay in 98 patients (73.2%). Our results have suggested that hospitalized patients with smear-positive pulmonary tuberculosis experience several delays. These delays may result in increased risk for transmission of infection. Decrease in the risk of infection for community and medical personal may only be obtained by preventing these delays.

Patterns of delays in diagnosis amongst patients with smear-positive pulmonary tuberculosis at a teaching hospital in Turkey

“…The median application interval in this study of 30 days compares favourably with reported median application intervals of 1.8 months in Korea [13], 120 days in Tanzania [11] and 8 weeks in Nigeria [8], but less favourably with median application intervals of 17.5 days in Turkey [12] and 3 weeks in Botswana [14]. The importance of a patient's delay was higher in the present study than in previous reports [9,12]. The median doctor's delay of 19 days was short compared with a median doctor's delay of 7 weeks in Malaysia [15], 8 weeks in Ghana [5] and 5 weeks in Botswana [14], but longer than that in other studies [8,16].…”

“…The importance of a patient's delay was higher in the present study than in previous reports [9,12] Malaysia [15], 8 weeks in Ghana [5] and 5 weeks in Botswana [14], but longer than that in other studies [8,16]. As reported elsewhere [9,12], the results indicated that the institutional delay was more significant than delays in diagnosis and treatment. The most common reasons for a doctor's delay were a low index of suspicion for tuberculosis on the part of physicians and healthcare system, as well as laboratory delays and the distance to a hospital.…”

Delays in the Diagnosis and Treatment of Pulmonary Tuberculosis

“…These time intervals are as follows (5,10,19): The patient's application interval: The patient's application interval was defined as the time interval between the onset of symptoms and the first doctor visit. Health care system interval: The health care system interval was defined as the time from the first doctor visit to the initiation of treatment.…”

“…Characteristics of the patients such as gender, age, level of education, economic status, smear status, distance to a physician or health center, patients' area of residence, presence of index case for tuberculosis, and symptoms may affect the length of patient and doctor delays (10,11,(19)(20)(21)(22)25,28). The most common potential reason for patient delay is the neglect of symptoms by the patient.…”

“…The most common potential reason for patient delay is the neglect of symptoms by the patient. A low index of suspicion for tuberculosis is an important reason for doctor delays (10,19,20,22,37). An assessment of the response to antibiotic therapy is a common approach in patients with pulmonary symptoms and abnormal chest x-ray findings, which may result in doctor delays (18,38).…”