Delayed diagnosis and associated factors among new pulmonary tuberculosis patients diagnosed at the emergency department of a tertiary care hospital in Porto Alegre, South Brazil: a prospective patient recruitment study

Gracieli Nadalon Deponti,Ana Cláudia Coelho,Alice Mânica Muller,Paulo De Tarso Roth Dalcin,Denise Rossato Silva

doi:10.1186/1471-2334-13-538

Gracieli Nadalon Deponti, Ana Cláudia Coelho + Show 3 more

Open Access

https://doi.org/10.1186/1471-2334-13-538

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Abstract

BackgroundControl of tuberculosis (TB) depends on early diagnosis and treatment at the primary health care level. However, many patients are still diagnosed late with TB at hospitals. The present study aimed to investigate the delay in diagnosis of TB patients at the emergency department.MethodsThis was a prospective study in a general, tertiary care, university-affiliated hospital of a city with a high prevalence of TB in Brazil. New TB patients ≥ 14 years diagnosed with pulmonary TB at the emergency department of Hospital de Clínicas de Porto Alegre were prospectively recruited between February 2010 and January 2012. The consenting patients meeting our inclusion criteria were interviewed using a pre-tested questionnaire. We evaluated the delay in time until diagnosis and identified factors associated with delayed diagnosis (patient and health care system delays).ResultsWe included 153 patients. The median total time of delay, patient delay, and health care system delay were 60 (interquartile range [IQR]: 30–90.5 days), 30 (lQR: 7–60 days), and 18 (IQR: 9–39.5 days) days, respectively. The factors that were independently associated with patient delay (time ≥ 30 days) were crack (odds ratio [OR] = 4.88, p = 0.043) and cocaine (OR = 6.68, p = 0.011) use. The factors that were independently associated with health care system delay (time ≥ 18 days) were weight loss (OR = 2.76, p = 0.025), miliary pattern (OR = 5.33, p = 0.032), and fibrotic changes (OR = 0.12, p = 0.013) on chest X-ray.ConclusionsPatient delay appears to be the main problem in this city with a high prevalence of TB in Brazil. The main factor associated with patient delay is drug abuse (crack and cocaine). Our study shows substance abuse programs need to be aware of control of TB, with health interventions focusing on TB education programs.

Highlights

Control of tuberculosis (TB) depends on early diagnosis and treatment at the primary health care level
The objective of this study was to investigate the delay in diagnosis of TB patients at the emergency department (ED) of a tertiary care hospital, and to analyze factors associated with patient and health care system delays
The factors that were independently associated with patient delay were cocaine and crack use

Summary

Introduction

Control of tuberculosis (TB) depends on early diagnosis and treatment at the primary health care level. Brazil is ranked 17th among 22 countries, and has the highest reported incidence of TB, with 42 cases/100,000 inhabitants in 2011 [1]. The city of Porto Alegre in southern Brazil had a rate of incidence of TB in 104 cases/100,000 inhabitants/ year in 2011 [2]. Control of TB in the community depends on early diagnosis and treatment. The total diagnosis delay is the sum of patient delay, and health system delay. The reported ranges of the average (median or mean) total diagnosis delay, patient delay, and health system delay are 25–185 days, 4.9– 162 days, and 2–87 days, respectively, for low, middle, and high income countries [5]

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