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KMID : 0383820130750060238
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Tuberculosis and Respiratory Diseases
2013 Volume.75 No. 6 p.238 ~ p.243
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Causes and Predictive Factors Associated with “Diagnosis Changed” Outcomes in Patients Notified as Tuberculosis Cases in a Private Tertiary Hospital
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Kang Byung-Ju
Jo Kyung-Wook
Park Tai-Sun
Yoo Jung-Wan
Lee Sei-Won
Choi Chang-Min
Oh Yeon-Mok
Lee Sang-Do
Kim Woo-Sung
Kim Dong-Soon
Shim Tae-Sun
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Abstract
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Background: The aim of our study was to evaluate the “diagnosis changed” rate in patients notified as tuberculosis (TB) on the Korean TB surveillance system (KTBS).
Materials and Methods: A total of 1,273 patients notified as TB cases on the KTBS in one private tertiary hospital in 2011 were enrolled in the present study. Patients were classified into three groups: “diagnosis maintained”, “diagnosis changed” (initially notified as TB, but ultimately diagnosed as non-TB), and “administrative error” (notified as TB due to administrative errors).
Results: Excluding 17 patients in the “administrative error” group, the “diagnosis maintained” and “diagnosis changed” groups included 1,097 (87.3%) and 159 patients (12.7%), respectively. Common causes of “diagnosis changed” were nontuberculous mycobacterial (NTM) disease (51.7%, 61/118), and pneumonia (17.8%) in cases notified as pulmonary TB, and meningitis (19.5%, 8/41) and Crohn’s disease (12.2%) in cases notified as extrapulmonary TB. Being older than 35 years of age (odds ratio [OR], 2.18) and a positive acid-fast bacilli stain (OR, 1.58) were positive predictors and a TB-related radiological finding (OR, 0.42) was a negative predictor for a “diagnosis changed” result via multivariate logistic regression analysis in pulmonary TB cases.
Conclusion: Because of a high “diagnosis changed” rate in TB notifications to the KTBS, the TB incidence rate measured by the KTBS may be overestimated. Considering the worldwide trend toward increased NTM disease, the “diagnosis changed” rate may increase over time. Thus, when reporting the annual TB notification rate in Korea, the exclusion of “diagnosis changed” cases is desirable.
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KEYWORD
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Nontuberculous Mycobacteria, Tuberculosis, Diagnostic Errors, Incidence
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