Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea.
Division of Pulmonary Medicine, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea.
JMIR Public Health Surveill. 2024 Apr 1;10:e47422. doi: 10.2196/47422.
Timely pulmonary tuberculosis (PTB) diagnosis is a global health priority for interrupting transmission and optimizing treatment outcomes. The traditional dichotomous time-divided approach for addressing time delays in diagnosis has limited clinical application because the time delay significantly varies depending on each community in question.
We aimed to reevaluate the diagnosis time delay based on the PTB disease spectrum using a novel scoring system that was applied at the national level in the Republic of Korea.
The Pulmonary Tuberculosis Spectrum Score (PTBSS) was developed based on previously published proposals related to the disease spectrum, and its validity was assessed by examining both all-cause and PTB-related mortality. In our analysis, we integrated the PTBSS into the Korea Tuberculosis Cohort Registry. We evaluated various time delays, including patient, health care, and overall delays, and their system-associated variables in line with each PTBSS. Furthermore, we reclassified the scores into distinct categories of mild (PTBSS=0-1), moderate (PBTBSS=2-3), and severe (PBTBSS=4-6) using a multivariate regression approach.
Among the 14,031 Korean patients with active PTB whose data were analyzed from 2018 to 2020, 37% (n=5191), 38% (n=5328), and 25% (n=3512) were classified as having a mild, moderate, and severe disease status, respectively, according to the PTBSS. This classification can therefore reflect the disease spectrum of PTB by considering the correlation of the score with mortality. The time delay patterns differed according to the PTBSS. In health care delays according to the PTBSS, greater PTB disease progression was associated with a shorter diagnosis period, since the condition is microbiologically easy to diagnose. However, with respect to patient delays, the change in elapsed time showed a U-shaped pattern as PTB progressed. This means that a remarkable patient delay in the real-world setting might occur at both apical ends of the spectrum (ie, in both mild and severe cases of PTB). Independent risk factors for a severe PTB pattern were age (adjusted odds ratio 1.014) and male sex (adjusted odds ratio 1.422), whereas no significant risk factor was found for mild PTB.
Timely PTB diagnosis should be accomplished. This can be improved with use of the PTBSS, a simple and intuitive scoring system, which can be more helpful in clinical and public health applications compared to the traditional dichotomous time-only approach.
及时发现肺结核（PTB）是全球卫生工作的重点，可中断传播并优化治疗效果。传统的时间划分方法将诊断延迟分为两部分，这种方法在临床中的应用具有局限性，因为时间延迟在很大程度上取决于每个社区的具体情况。
我们旨在利用一种新的评分系统重新评估基于结核病疾病谱的诊断延迟，该评分系统已在大韩民国全国范围内应用。
根据与疾病谱相关的已发表建议，开发了肺结核疾病谱评分（PTBSS），并通过检查全因死亡率和与肺结核相关的死亡率来评估其有效性。在我们的分析中，我们将 PTBSS 纳入韩国结核病队列登记处。我们评估了各种时间延迟，包括患者、医疗保健和整体延迟，以及与每个 PTBSS 相关的系统变量。此外，我们使用多元回归方法将分数重新分类为轻度（PTBSS=0-1）、中度（PTBSS=2-3）和重度（PTBSS=4-6）。
在纳入了 2018 年至 2020 年期间患有活动性肺结核的 14031 名韩国患者的数据中，37%（n=5191）、38%（n=5328）和 25%（n=3512）的患者分别被分类为轻度、中度和重度疾病状态，这是根据 PTBSS 进行的分类。因此，该分类可以通过考虑分数与死亡率的相关性来反映肺结核的疾病谱。根据 PTBSS，时间延迟模式因疾病严重程度而异。在根据 PTBSS 评估的医疗保健延迟方面，由于病情在微生物学上易于诊断，因此病情的进展与较短的诊断时间相关。然而，对于患者延迟，随着时间的流逝，变化呈 U 型模式，因为在现实世界中，肺结核的两端（即肺结核的轻度和重度病例）都可能出现显著的患者延迟。严重肺结核模式的独立危险因素为年龄（调整优势比 1.014）和男性（调整优势比 1.422），而轻度肺结核无明显危险因素。
应及时进行肺结核诊断。使用简单直观的 PTBSS 可以改善这种情况，与传统的仅基于时间的二分法相比，PTBSS 在临床和公共卫生应用中可能更有帮助。
