Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore.
Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore.
Singapore Med J. 2021 Jun;62(6):296-299. doi: 10.11622/smedj.2020027. Epub 2020 Mar 17.
It is vital to diagnose and treat pulmonary tuberculosis (PTB) early, in the interests of the patient and public health. At the Singapore Tuberculosis Control Unit (TBCU), it was not uncommon to discover abnormal chest radiographs (CXRs) predating their PTB diagnosis by months to years in the electronic medical records (EMRs) of sputum acid-fast bacilli smear-positive patients. Our study explored this observation.
The EMRs of sputum smear-positive PTB patients treated at the TBCU from January to July 2014 were viewed for abnormal CXRs preceding their PTB diagnosis. Information in the EMRs pertaining to the indication for the CXRs, radiological reports (including whether the possibility of PTB was stated) and action taken was captured.
Of the 254 sputum smear-positive patients, 108 had previous CXRs in their EMRs, of whom 39 (36.1%) had previous CXRs compatible with PTB. Most of these were performed in tertiary institutions and for reasons unrelated to PTB. No action was taken in response to these CXRs in 24 (61.5%) patients. 27 (69.2%) patients had abnormal CXRs dating back more than six months, with 12 (30.8%) dating back more than 30 months before the PTB diagnosis. Patients aged ≥ 55 years were significantly more likely to have previous CXRs that were compatible with PTB.
PTB patients may be asymptomatic or have chronic indolent disease and remain undiagnosed for years. There is a need for vigilance within our healthcare system to seize opportunities for early diagnosis and treatment to prevent the spread of this infectious disease in Singapore.
早期诊断和治疗肺结核（PTB）至关重要，这关系到患者和公共卫生的利益。在新加坡结核病控制单位（TBCU），在痰抗酸杆菌涂片阳性患者的电子病历（EMR）中，经常发现其 PTB 诊断前数月至数年的异常胸部 X 光片（CXR）。我们的研究对此进行了探讨。
查看 2014 年 1 月至 7 月在 TBCU 治疗的痰涂片阳性 PTB 患者的 EMR，以查找其 PTB 诊断前的异常 CXR。从 EMR 中捕获与 CXR 指征、放射学报告（包括是否陈述了 PTB 的可能性）和所采取的行动有关的信息。
在 254 例痰涂片阳性患者中，108 例 EMR 中有先前的 CXR，其中 39 例（36.1%）有先前符合 PTB 的 CXR。这些 CXR 大多是在三级医疗机构进行的，且与 PTB 无关。在没有采取行动的 24 例（61.5%）患者中，有 27 例患者的 CXR 异常，超过 6 个月，其中 12 例（30.8%）的 CXR 异常在 PTB 诊断前超过 30 个月。≥55 岁的患者明显更有可能有先前符合 PTB 的 CXR。
PTB 患者可能无症状或患有慢性惰性疾病，多年未被诊断。我们的医疗体系需要保持警惕，抓住早期诊断和治疗的机会，以防止这种传染病在新加坡的传播。
