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KMID : 0338420210360000151
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The Korean Journal of Internal Medicine
2021 Volume.36 No. 0 p.151 ~ p.159
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Characteristics and risk factors associated with missed diagnosis in patients with smear-negative pulmonary tuberculosis
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Kwak Se-Hyun
Choi Ji-Soo
Lee Eun-Hye
Lee Su-Hwan
Leem Ah-Young
Lee Sang-Hoon
Kim Song-Yee
Chung Kyung-Soo
Jung Ji-Ye
Park Moo-Suk
Kim Young-Sam
Chang Joon
Kang Young-Ae
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Abstract
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Background/Aims: Delayed diagnosis and treatment of smear-negative pulmonary tuberculosis (TB) are major concerns for TB control. We evaluated characteristics of patients with smear-negative pulmonary TB who received a delayed diagnosis and identified risk factors that may have contributed to this delay.
Methods: We reviewed medical records of patients with smear-negative culture-positive pulmonary TB treated at a tertiary care hospital in South Korea between January 2017 and December 2018. Patients who initiated anti-TB treatment after positive cultures were included in the missed TB group, and those who initiated empirical treatment before positive cultures were included in the control group.
Results: Of 220 patients included, 117 (53.2%) and 103 (46.8%) were in the missed TB and control groups, respectively. Patients in the missed TB group were older (p = 0.001) and had a higher mean body mass index (BMI) (p = 0.019). Comorbidities (66.9% vs. 46.6%, p = 0.003) and immunocompromised patients (33.1% vs. 20.4%, p = 0.035) were more common in the missed TB group than in the control group. Old age (odds ratio [OR], 1.030; 95% confidence interval [CI], 1.012 to 1.048; p = 0.001), high BMI (OR, 1.114; 95% CI, 1.004 to 1.237; p = 0.042), and negative polymerase chain reaction (PCR) results (OR, 9.551; 95% CI, 4.925 to 18.521; p < 0.001) were associated with delayed diagnosis.
Conclusions: In more than half of patients with smear-negative pulmonary TB, the diagnosis was delayed. Patients with delayed TB diagnosis were older, had higher BMI, and negative PCR results.
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KEYWORD
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Lung disease, Tuberculosis, Diagnosis, Risk factors
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