Infection Control Room and Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
Am J Med Sci. 2010 Nov;340(5):367-72. doi: 10.1097/MAJ.0b013e3181e92b06.
Healthcare system delays in the diagnosis of tuberculosis can increase the risk of its nosocomial transmission. We aimed to determine whether different physicians' specialties and experience influenced this diagnostic delay.
We retrospectively reviewed the cases of 167 patients with smear-positive pulmonary tuberculosis who were hospitalized from September, 2004, to August, 2006, for 5 components of healthcare system delays according to the World Health Organization definitions and analyzed the impact of physicians' specialties and their experience (annual number of patients treated for tuberculosis) on these delays.
The median suspicion delay was significantly longer for patients in surgical departments than those in medical departments (4 days versus 1 day, P = 0.001) and for patients treated by nontuberculosis specialists than those treated by tuberculosis specialists (including pulmonologists, infectious diseases specialists and thoracic surgeons; 3 days versus 1 day, P < 0.001). Both were independent factors related to suspicion delay examined by multivariate analysis. The annual number of tuberculosis patients in each department had a significant negative correlation with suspicion delay (r = -0.303, P < 0.001).
Patients treated by surgeons and nontuberculosis specialists who were inexperienced in treating tuberculosis experienced a longer suspicion delay. Enhancing knowledge about tuberculosis among all physicians in the hospital, encouraging staff to consult tuberculosis specialists to confirm a diagnosis and implementing early alarm systems are crucial to improving the correct diagnosis of tuberculosis and to reducing delays in treatment.
医疗保健系统中结核病诊断的延迟会增加其医院内传播的风险。我们旨在确定不同医生的专业和经验是否会影响这种诊断延迟。
我们回顾性地分析了 2004 年 9 月至 2006 年 8 月期间因涂片阳性肺结核住院的 167 例患者的病例，根据世界卫生组织的定义，分析了医疗保健系统延迟的 5 个组成部分，并分析了医生的专业和经验（每年治疗的结核病患者人数）对这些延迟的影响。
外科部门患者的怀疑延迟中位数明显长于内科部门患者（4 天比 1 天，P = 0.001），非结核病专家治疗的患者比结核病专家治疗的患者（包括肺病专家、传染病专家和胸外科医生）的怀疑延迟中位数也明显更长（3 天比 1 天，P < 0.001）。这两者都是通过多变量分析确定的与怀疑延迟相关的独立因素。每个科室的每年结核病患者人数与怀疑延迟呈显著负相关（r = -0.303，P < 0.001）。
由经验不足治疗结核病的外科医生和非结核病专家治疗的患者的怀疑延迟时间较长。增强医院内所有医生对结核病的认识，鼓励工作人员咨询结核病专家以确认诊断，并实施早期警报系统，对于改善结核病的正确诊断和减少治疗延迟至关重要。
