Predictors of Suspected Pulmonary TB in an Isolation Room of an ED

急診隔離室疑似肺結核病患之臨床表徵

陳邦彥(Pang-Yen Chen) ； 曾嘉瑩(Chia-Ying Tseng) ； 范渚鑫(Ju-Sing Fan) ； 黃獻皞(Hsien-Hao Huang) ； 陳啟華(Chii-Hwa Chern) ； 陳威廷(Wei-Teing Chen) ； 顏鴻章(David Hung-Tsang Yen) ； 黃俊一(Chun-I Huang)

《中華民國急救加護醫學會雜誌》 21卷3期 (2010/09) Pp. 125-134

https://doi.org/10.30018/JECCM.201009.0001

摘要

Background: Early detection and isolation of pulmonary tuberculosis (PTB) patients are the key stones in controlling the disease. The objective of the study was to investigate the characteristics of PTB and non-PTB patients in emergent department (ED) isolation room and help us to early diagnosis and recognition of suspected PTB patients in ED.
Design: Retrospective chart review.
Methods: From January 1, 2005, through December 31, 2005, 127 adult patients admitted to the ED isolation room were enrolled under the suspicion of PTB infection. Medical records including demographic data, results of sputum stain and culture, and hospital days were retrospectively reviewed and analyzed.
Results: PTB was disclosed in 82 (64.6%) of total 127 patients or 49 (52.1%) of 94 patients if excluded 33 transferred PTB patients who were confirmed in other hospital. The PTB group had lower white blood cell counts (WBCx103) (8.8±3.4 vs 12.4±5.3, p＜0.001) and C-reactive protein (CRP) (6.9±6.9 mg/dl vs 12.5±10.2 mg/dl, p=0.002) than the non-PTB group. The likelihood ratio of PTB was 7.96 when CXR showed a high suspicion of active PTB and elevated to 9.20 when both CXR and chest CT reports favored active PTB. Independent factors of the PTB group, based on multiple logistic regression analyses, were WBCx103 (odds ratio [OR], 0.795; P＜0.001), fibronodular change of upper lung field in CXR (OR, 8.499; P＜ 0.001), pleural thickening in CXR (OR, 4.880; P＜ 0.05). The area under the receiver-operating characteristic (ROC) curve for the model was 85.4% (P＜0.001), suggesting good model discrimination.
Conclusions: Almost half of patients were finally diagnosed as PTB (52.1%, 49/94). Isolation rooms do provide suitable places for suspected PTB patients and play an important role in controlling the spreading of PTB in an ED. We identified normal WBC, fibronodular change of upper lung field and pleural thickening in CXR were significant independent predictors.

關鍵字

急診室 ； 肺結核 ； 隔離室

並列摘要

Background: Early detection and isolation of pulmonary tuberculosis (PTB) patients are the key stones in controlling the disease. The objective of the study was to investigate the characteristics of PTB and non-PTB patients in emergent department (ED) isolation room and help us to early diagnosis and recognition of suspected PTB patients in ED.
Design: Retrospective chart review.
Methods: From January 1, 2005, through December 31, 2005, 127 adult patients admitted to the ED isolation room were enrolled under the suspicion of PTB infection. Medical records including demographic data, results of sputum stain and culture, and hospital days were retrospectively reviewed and analyzed.
Results: PTB was disclosed in 82 (64.6%) of total 127 patients or 49 (52.1%) of 94 patients if excluded 33 transferred PTB patients who were confirmed in other hospital. The PTB group had lower white blood cell counts (WBCx103) (8.8±3.4 vs 12.4±5.3, p＜0.001) and C-reactive protein (CRP) (6.9±6.9 mg/dl vs 12.5±10.2 mg/dl, p=0.002) than the non-PTB group. The likelihood ratio of PTB was 7.96 when CXR showed a high suspicion of active PTB and elevated to 9.20 when both CXR and chest CT reports favored active PTB. Independent factors of the PTB group, based on multiple logistic regression analyses, were WBCx103 (odds ratio [OR], 0.795; P＜0.001), fibronodular change of upper lung field in CXR (OR, 8.499; P＜ 0.001), pleural thickening in CXR (OR, 4.880; P＜ 0.05). The area under the receiver-operating characteristic (ROC) curve for the model was 85.4% (P＜0.001), suggesting good model discrimination.
Conclusions: Almost half of patients were finally diagnosed as PTB (52.1%, 49/94). Isolation rooms do provide suitable places for suspected PTB patients and play an important role in controlling the spreading of PTB in an ED. We identified normal WBC, fibronodular change of upper lung field and pleural thickening in CXR were significant independent predictors.

並列關鍵字

emergent department ED ； pulmonary tuberculosis PTB ； isolation room