Lewis K E, Stephens C, Shahidi M M, Packe G
Newham Healthcare NHS Trust, Newham General Hospital, Glen Road, Plaistow, London E13 8RU.
Commun Dis Public Health. 2003 Jun;6(2):133-8.
In the United Kingdom there is little information about the delay between the onset of symptoms in patients with tuberculosis and the time it takes for them to be correctly diagnosed and treatment started. We have examined the duration and possible causes of such delay in our own district. The records of 93 patients were examined. Total delay in starting treatment was estimated as the time from the start of symptoms to commencement of chemotherapy. Patient delays were estimated from the time between the start of symptoms to the time taken to first attend their general practitioner (GP) with symptoms. Healthcare system delays were estimated from the interval between first being assessed by their GP and starting anti-tuberculosis treatment. Median total delay was 18 weeks (0-219). The time when patients first presented to their GP was determined for 64 patients: median patient delay was then estimated as nine weeks (range 0-104 weeks), and median healthcare delay five weeks, with a very wide range (0.5-210). Prolonged delay was seen in three patients with cervical lymph node disease. Patient delay was significantly longer than healthcare system delay (p = 0.019). Pulmonary disease was associated with shorter total delay in starting treatment compared with extra-pulmonary disease (p = 0.035). In patients with tuberculosis there were considerable delays in first presentation to medical services, in diagnosis and in starting treatment. Patient delays were longer than healthcare system delays. There is a need to improve awareness of the symptoms of tuberculosis both on the part of the general population and of health professionals, especially in areas of high incidence.
在英国，关于结核病患者症状出现与正确诊断及开始治疗之间的延迟情况，几乎没有相关信息。我们对本地区这种延迟的时长及可能原因进行了调查。研究了93名患者的记录。开始治疗的总延迟时间被估算为从症状出现到开始化疗的时间。患者延迟时间是从症状出现到因症状首次就诊于全科医生（GP）的时间来估算的。医疗系统延迟时间是从首次由全科医生评估到开始抗结核治疗的间隔时间来估算的。总延迟时间的中位数为18周（0 - 219周）。确定了64名患者首次就诊于全科医生的时间：患者延迟时间的中位数估算为9周（范围0 - 104周），医疗系统延迟时间的中位数为5周，范围非常广（0.5 - 210周）。3例颈部淋巴结疾病患者出现了长时间延迟。患者延迟时间显著长于医疗系统延迟时间（p = 0.019）。与肺外疾病相比，肺部疾病开始治疗的总延迟时间较短（p = 0.035）。结核病患者在首次就医、诊断及开始治疗方面存在相当长的延迟。患者延迟时间长于医疗系统延迟时间。有必要提高普通人群和卫生专业人员对结核病症状的认识，尤其是在高发病率地区。
