Factors associated with delayed recognition of pulmonary tuberculosis in emergency departments in Taiwan

Objective: To identify and evaluate factors associated with delayed recognition of pulmonary tuberculosis (TB) in the emergency department (ED). Background: Delayed recognition of pulmonary TB in ED may precipitate mortality and morbidity. Methods: Medical records of newly diagnosed TB patients admitted to four hospitals in Taiwan were retrospectively reviewed. Patients were divided into two groups based on ED physicians' recognition or not of TB and statistically compared to identify differences in their characteristics. Results: 310 newly diagnosed TB patients were identified; 150 were unrecognized in the ED. Cough, chest tightness, general malaise, and body weight loss were more common for those with recognized TB. Older age (≥65yrs, P=0.035) and chronic renal insufficiency (P=0.005) were associated with delayed TB recognition. Conclusion: Older age and chronic renal insufficiency are risk factors for delayed TB while in the ED. Typical symptoms should heighten alertness for recognizing TB.