Abstract
BackgroundCurrently, there is limited data on the risk factors associated with treatment delay in tuberculous meningitis (TBM). This study aimed to assess the duration of delay in the treatment TBM and to investigate its determinants.MethodsDuring the period from September 2009 to February 2016, a retrospective cohort study of consecutive TBM patients admitted to our hospital was conducted to determine the risk factors associated with treatment delay in TBM. Treatment delay duration was defined as the time interval from onset of symptoms (by patient recall) to initiation of treatment and was stratified into two categories: ≤ 20 days, >20 days (median delay day is 20 days). Data collected included demography, comorbidity, cerebrospinal fluid (CSF) examinations and others. Univariable and multivariable logistic regression analysis was used to evaluate the determinants of treatment delay.ResultsA total of 161 TBM patients were included in our study, all were confirmed by CSF mycobacterial culture. The median treatment delay for all patients included in the study was 20 days [interquartile range, 14–60 days]. Multivariate analysis revealed that age (≤21 years old, OR = 0.202, 95% CI: 0.079, 0.521), fever (OR = 0.414, 95% CI: 0.180, 0.952), and headache (OR = 0.204, 95% CI: 0.095, 0.442) had significantly lower risk for treatment delay, while multiple healthcare contact (>3 times) (OR = 3.938, 95% CI: 1.326, 11.691) as well as CSF chloride (>111 mmol/L) (OR = 2.479, 95% CI: 1.143, 5.377) had significantly higher risk of the delay.ConclusionsOur findings indicate that multiple healthcare contact and high CSF chloride predict the risk of long delay, while young age, fever and headache are associated with short delay. Maintained focus on awareness of TBM in the population and in healthcare systems, and continuous implementation of diagnostic methods for TBM to detect the disease early, may reduce the mortality and morbidity.
Highlights
There is limited data on the risk factors associated with treatment delay in tuberculous meningitis (TBM)
We conducted a retrospective cohort study of consecutive TBM patients admitted to Shandong Provincial Chest Hospital (SPCH) to determine the risk factors associated with treatment delay
A total of 161 TBM patients were included in our study, all were confirmed by cerebrospinal fluid (CSF) mycobacterial culture
Summary
There is limited data on the risk factors associated with treatment delay in tuberculous meningitis (TBM). A number of factors have been reported to be associated with poor outcome Some of these factors are diagnosis delay; severity of TBM at the time of admission; the presence of headache, fever and hydrocephalus; high cerebrospinal fluid (CSF) protein and lactate concentration [3, 4]. A study conducted in Taiwan, showed that 47.6% of patients experienced delay in initiating appropriate treatment [3]. Until now, He et al BMC Infectious Diseases (2017) 17:341 several studies have proved that treatment delay is strongly associated with poor outcomes in adults or children [2, 5,6,7,8,9]
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