Effective tuberculosis (TB) control relies on early diagnosis and prompt commencement of treatment. Australia has maintained a low annual incidence rate of TB since the mid-1980s of 5-6 cases per 100, 000 persons. This study aimed to investigate delays in diagnosis of pulmonary TB in a low incidence setting.
A retrospective study was conducted in a tertiary teaching hospital in Melbourne, Victoria, Australia. Symptomatic patients ≥ 18 years with a new diagnosis of pulmonary tuberculosis that were commenced on treatment between 1st December 2011 and 1st December 2014 were identified for enrolment via Victorian Department of Public Health notification data and hospital Australian Discharge Related Group codes.
133 patients were included in the study. The median duration of patient delay, health care system delay and total delay in diagnosis were 28 [13-90], 18 [7-53] and 89 [22-151] days, respectively. Median duration from hospital admission to diagnosis was 3 [0-8] days. Factors associated with increased patient delay included weight loss (OR 3.5, 95%CI 1.7-7.2, p<0.001) and increased smoking pack years (Mean 5.83 vs 14.07, p=0.01). Factors associated with increased health care delay included migration from a low risk country (OR 8.74, 95% CI 1.06-72.20, p=0.04) and outpatient clinic review (OR 8.96 95% CI 3.9-20.3, p<0.001). Protective factors against health care delay included cough (OR 0.11, 95%CI 0.01-0.93, p=0.02), haemoptysis (OR 0.31, 95%CI 0.12-0.81, p=0.01), emergency (OR 0.34, 95%CI 0.17-0.71, p=0.01) or hospital (OR 0.13, 95%CI 0.04-0.41, p<0.001) admission and sputum smear (OR 0.15, 95%CI 0.06-0.37, p<0.001), culture (OR 0.38, 95%CI 0.15-0.98, p=0.04) or Gene Xpert (OR 0.50, 95% CI 0.25-0.99, p=0.05) positivity. Older age was associated with increased total delay to diagnosis (median 32 [25-50] vs 42 [26-62], p=0.01).
In a low-incidence, high-resource country, patient delays contribute most to total health care delay. Longer total delays are seen in older patients. Healthcare delays are longer in those reviewed in an outpatient setting; whereas admission to the emergency department or ward are protective against health care delays. Positive sputum smears and Gene Xpert also reduce healthcare delays.
G. Lane, None