Abstract
BackgroundDelay in diagnosis and treatment worsens the disease and clinical outcomes, which further enhances the transmission of tuberculosis (TB) in the community. Therefore, this study aims to assess treatment delay and its associated factors among childhood pleural TB patients in China.MethodsBetween January 2006 and December 2019, consecutive patients aged ≤15 years with definite or possible pleural TB were included for analysis. Treatment delay duration was defined as the time interval from the onset of symptoms to treatment initiation and was stratified into two categories: < 30 days, ≥30 days (median delay day is 30 days). The electronic medical records of children were reviewed to obtain demographic characteristics, clinical characteristics, laboratory examinations, and radiographic findings. Univariate and multivariate logistic regressions were used to explore the factors associated with treatment delay in patients.ResultsA total of 154 children with pleural TB were included, with a mean age of 12.4 ± 3.3 years. The median treatment delay was 30 days (interquartile range, 10–60 days) and 51.3% (n = 79) of patients underwent a treatment delay. Multivariate analysis revealed that heart rate (≤92 beats/min, age-adjusted OR = 2.503, 95% CI: 1.215, 5.155) and coefficient of variation of red cell distribution width (RDW-CV, ≥12.9%, age-adjusted OR = 4.705, 95% CI: 2.048, 10.811) were significant risk factors for treatment delays in childhood pleural TB.ConclusionOur findings suggested that a significant treatment delay occurs among children with pleural TB in China. Patients with a low heart rate or a high RDW-CV experienced delays in the initiation of anti-TB therapy. Therefore, well awareness of the associations between clinical characteristics and treatment delay may improve the management of children with pleural TB and enable us to develop preventive strategies to reduce the treatment delay.
Highlights
Delay in diagnosis and treatment worsens the disease and clinical outcomes, which further enhances the transmission of tuberculosis (TB) in the community
According to the World Health Organization (WHO), 10.0 million people fell ill with tuberculosis (TB), 1.2 million TB deaths occurred among HIV-negative people and 251,000 TB deaths occurred among HIV-positive people in 2018 [1]
Our study suggests that a lower heart rate or a higher RDW-CV were associated with treatment delay
Summary
Delay in diagnosis and treatment worsens the disease and clinical outcomes, which further enhances the transmission of tuberculosis (TB) in the community. This study aims to assess treatment delay and its associated factors among childhood pleural TB patients in China. Several descriptive cases highlighting the clinical characteristics of childhood pleural TB have been reported [5, 6, 9,10,11], the epidemiological characteristics, such as surgical risk and delay in treatment, remain unclear. In a study conducted by Cheng S et al, delayed TB treatment was associated with a significantly increased risk of pulmonary sputum smear positivity and pulmonary cavity [16]. A previous report suggested that delay in anti-TB treatment is an important risk factor for chronic obstructive pulmonary disease [17]
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