Diagnosis and Treatment of Pulmonary Tuberculosis in Hospitalized Patients Are Affected by Physician Specialty and Experience

Abstract

IntroductionHealthcare 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. MethodsWe 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. ResultsThe median suspicion delay was significantly longer for patients in surgical departments than those in medical departments (4days versus 1day, P=0.001) and for patients treated by nontuberculosis specialists than those treated by tuberculosis specialists (including pulmonologists, infectious diseases specialists and thoracic surgeons; 3days versus 1day, 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). ConclusionsPatients 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.