Rao V K, Iademarco E P, Fraser V J, Kollef M H
Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Ann Intern Med. 1999 Mar 2;130(5):404-11. doi: 10.7326/0003-4819-130-5-199903020-00004.
Despite increased awareness of tuberculosis, delays in management are common.
To investigate management delays among hospitalized patients with tuberculosis.
Retrospective cohort study.
The Barnes-Jewish-Christian Health System, a network of eight community and tertiary-care facilities serving the St. Louis, Missouri, metropolitan area.
All 203 patients with tuberculosis hospitalized in the Barnes-Jewish-Christian Health System from 1988 to 1996.
Time from admission to first consideration of the diagnosis (suspicion interval), first consideration and treatment initiation (treatment interval), and admission and treatment initiation (overall management interval) were determined. Delays were defined as intervals longer than 24 hours.
The overall management interval (median, 6 days [5th and 95th percentiles, 1 and 52 days]) exceeded 24 hours in 152 patients (74.9% [95% CI, 68.9% to 80.9%]). The suspicion interval (median, 1 day [5th and 95th percentiles, 0 and 16 days]) exceeded 24 hours in 54 patients (26.6% [CI, 20.5% to 32.7%]), and the treatment interval (median, 3 days [5th and 95th percentiles, 0 and 51 days]) was prolonged in 130 patients (64.0% [CI, 57.4% to 70.6%]). Overall management delays of more than 10 and 25 days occurred in 33.5% (CI, 27.0% to 40.0%) and 18.7% (CI, 13.3% to 24.1%) of patients, respectively. The 55 patients with smears that were positive for acid-fast bacilli had a median treatment interval of 3 days (5th and 95th percentiles, 0 and 33 days); in 58.2% of patients (CI, 45.2% to 71.2%), this interval exceeded 24 hours.
Delays in initiation of treatment were more common than delays in the initial suspicion of tuberculosis. Both types of delays were common even in patients with disease that was confirmed by a positive smear. These data illustrate a need for improved education of physicians about the benefits of early initiation of therapy for tuberculosis.
尽管对结核病的认识有所提高，但治疗延迟的情况仍很常见。
调查住院结核病患者的治疗延迟情况。
回顾性队列研究。
巴恩斯-犹太-基督教医疗系统，这是一个由八个社区和三级医疗设施组成的网络，服务于密苏里州圣路易斯市的大都市区。
1988年至1996年期间在巴恩斯-犹太-基督教医疗系统住院的所有203例结核病患者。
确定从入院到首次考虑诊断的时间（怀疑间隔）、首次考虑诊断和开始治疗的时间（治疗间隔）以及入院和开始治疗的时间（总体管理间隔）。延迟定义为间隔超过24小时。
总体管理间隔（中位数为6天[第5和第95百分位数为1和52天]）在152例患者中超过24小时（74.9%[95%置信区间，68.9%至80.9%]）。怀疑间隔（中位数为1天[第5和第95百分位数为0和16天]）在54例患者中超过24小时（26.6%[置信区间，20.5%至32.7%]），治疗间隔（中位数为3天[第5和第95百分位数为0和51天]）在130例患者中延长（64.0%[置信区间，57.4%至70.6%]）。分别有33.5%（置信区间，2
