Implementation of an emergency department triage procedure for the detection and isolation of patients with active pulmonary tuberculosis

Peter E. Sokolove, Brian S. Lee, Jennifer A. Krawczyk, Peter T. Banos, Aric L. Gregson, Dineke M. Boyce, Roger J. Lewis

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Study objectives: To investigate the ability of an emergency department screening protocol to initiate respiratory isolation of patients with pulmonary tuberculosis at ED triage before chest radiography. Methods: We conducted a prospective cohort study with retrospective medical record review of adult patients who presented for care to an urban, university-affiliated hospital in Los Angeles County over a 4-month period. Ambulatory patients were administered a triage screening protocol that used patient-reported tuberculosis risk factors and symptoms in combination with selective chest radiography to screen patients at ED triage for active pulmonary tuberculosis. Results: A total of 10,674 patients were screened; 2,218 were isolated at triage and underwent chest radiography, and 378 were kept in isolation in the ED. The respiratory isolation of pulmonary tuberculosis (RIPT) protocol detected 17 of 27 visits made by patients with unsuspected pulmonary tuberculosis, yielding a sensitivity of 63% (95% confidence interval [Cl] 42% to 81%). The estimated specificity was 78%. For each patient with tuberculosis who was detected by the RIPT protocol, 624 patients were screened at triage, 130 chest radiographs were taken, and 22 patients were placed in respiratory isolation in the ED. Patients with undetected pulmonary tuberculosis more commonly had nonpulmonary chief complaints (76% versus 20%; odds ratio [OR] 13, 95% Cl 2.1 to 78.3), and only 60% (95% Cl 26% to 88%) were ultimately isolated in the hospital. Among RIPT screen-positive patients, radiographic findings predictive of pulmonary tuberculosis were cavitary lesions (OR 84.3, 95% Cl 22.6 to 315), upper lobe infiltrates (OR 24.2, 95% Cl 9.1 to 64.4), pleural effusions (OR 8.9, 95% Cl 2.5 to 31.8), diffuse/interstitial infiltrates (OR 5.7, 95% Cl 1.8 to 17.9), and non-upper lobe infiltrates (OR 3.1, 95% Cl 1.0 to 9.5). Conclusion: The RIPT screening protocol was only moderately sensitive for isolating patients with pulmonary tuberculosis at ED triage. Future studies should evaluate modified and abridged screening protocols, as well as the cost-effectiveness of triage screening.

Original languageEnglish (US)
Pages (from-to)327-336
Number of pages10
JournalAnnals of Emergency Medicine
Volume35
Issue number4
StatePublished - 2000

Fingerprint

Patient Isolation
Triage
Pulmonary Tuberculosis
Hospital Emergency Service
Odds Ratio
Thorax
Radiography
Tuberculosis
Los Angeles
Pleural Effusion
Cost-Benefit Analysis
Medical Records

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Sokolove, P. E., Lee, B. S., Krawczyk, J. A., Banos, P. T., Gregson, A. L., Boyce, D. M., & Lewis, R. J. (2000). Implementation of an emergency department triage procedure for the detection and isolation of patients with active pulmonary tuberculosis. Annals of Emergency Medicine, 35(4), 327-336.

Implementation of an emergency department triage procedure for the detection and isolation of patients with active pulmonary tuberculosis. / Sokolove, Peter E.; Lee, Brian S.; Krawczyk, Jennifer A.; Banos, Peter T.; Gregson, Aric L.; Boyce, Dineke M.; Lewis, Roger J.

In: Annals of Emergency Medicine, Vol. 35, No. 4, 2000, p. 327-336.

Research output: Contribution to journalArticle

Sokolove, PE, Lee, BS, Krawczyk, JA, Banos, PT, Gregson, AL, Boyce, DM & Lewis, RJ 2000, 'Implementation of an emergency department triage procedure for the detection and isolation of patients with active pulmonary tuberculosis', Annals of Emergency Medicine, vol. 35, no. 4, pp. 327-336.
Sokolove, Peter E. ; Lee, Brian S. ; Krawczyk, Jennifer A. ; Banos, Peter T. ; Gregson, Aric L. ; Boyce, Dineke M. ; Lewis, Roger J. / Implementation of an emergency department triage procedure for the detection and isolation of patients with active pulmonary tuberculosis. In: Annals of Emergency Medicine. 2000 ; Vol. 35, No. 4. pp. 327-336.
@article{a72471700cf9473da748687654ea760a,
title = "Implementation of an emergency department triage procedure for the detection and isolation of patients with active pulmonary tuberculosis",
abstract = "Study objectives: To investigate the ability of an emergency department screening protocol to initiate respiratory isolation of patients with pulmonary tuberculosis at ED triage before chest radiography. Methods: We conducted a prospective cohort study with retrospective medical record review of adult patients who presented for care to an urban, university-affiliated hospital in Los Angeles County over a 4-month period. Ambulatory patients were administered a triage screening protocol that used patient-reported tuberculosis risk factors and symptoms in combination with selective chest radiography to screen patients at ED triage for active pulmonary tuberculosis. Results: A total of 10,674 patients were screened; 2,218 were isolated at triage and underwent chest radiography, and 378 were kept in isolation in the ED. The respiratory isolation of pulmonary tuberculosis (RIPT) protocol detected 17 of 27 visits made by patients with unsuspected pulmonary tuberculosis, yielding a sensitivity of 63{\%} (95{\%} confidence interval [Cl] 42{\%} to 81{\%}). The estimated specificity was 78{\%}. For each patient with tuberculosis who was detected by the RIPT protocol, 624 patients were screened at triage, 130 chest radiographs were taken, and 22 patients were placed in respiratory isolation in the ED. Patients with undetected pulmonary tuberculosis more commonly had nonpulmonary chief complaints (76{\%} versus 20{\%}; odds ratio [OR] 13, 95{\%} Cl 2.1 to 78.3), and only 60{\%} (95{\%} Cl 26{\%} to 88{\%}) were ultimately isolated in the hospital. Among RIPT screen-positive patients, radiographic findings predictive of pulmonary tuberculosis were cavitary lesions (OR 84.3, 95{\%} Cl 22.6 to 315), upper lobe infiltrates (OR 24.2, 95{\%} Cl 9.1 to 64.4), pleural effusions (OR 8.9, 95{\%} Cl 2.5 to 31.8), diffuse/interstitial infiltrates (OR 5.7, 95{\%} Cl 1.8 to 17.9), and non-upper lobe infiltrates (OR 3.1, 95{\%} Cl 1.0 to 9.5). Conclusion: The RIPT screening protocol was only moderately sensitive for isolating patients with pulmonary tuberculosis at ED triage. Future studies should evaluate modified and abridged screening protocols, as well as the cost-effectiveness of triage screening.",
author = "Sokolove, {Peter E.} and Lee, {Brian S.} and Krawczyk, {Jennifer A.} and Banos, {Peter T.} and Gregson, {Aric L.} and Boyce, {Dineke M.} and Lewis, {Roger J.}",
year = "2000",
language = "English (US)",
volume = "35",
pages = "327--336",
journal = "Annals of Emergency Medicine",
issn = "0196-0644",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Implementation of an emergency department triage procedure for the detection and isolation of patients with active pulmonary tuberculosis

AU - Sokolove, Peter E.

AU - Lee, Brian S.

AU - Krawczyk, Jennifer A.

AU - Banos, Peter T.

AU - Gregson, Aric L.

AU - Boyce, Dineke M.

AU - Lewis, Roger J.

PY - 2000

Y1 - 2000

N2 - Study objectives: To investigate the ability of an emergency department screening protocol to initiate respiratory isolation of patients with pulmonary tuberculosis at ED triage before chest radiography. Methods: We conducted a prospective cohort study with retrospective medical record review of adult patients who presented for care to an urban, university-affiliated hospital in Los Angeles County over a 4-month period. Ambulatory patients were administered a triage screening protocol that used patient-reported tuberculosis risk factors and symptoms in combination with selective chest radiography to screen patients at ED triage for active pulmonary tuberculosis. Results: A total of 10,674 patients were screened; 2,218 were isolated at triage and underwent chest radiography, and 378 were kept in isolation in the ED. The respiratory isolation of pulmonary tuberculosis (RIPT) protocol detected 17 of 27 visits made by patients with unsuspected pulmonary tuberculosis, yielding a sensitivity of 63% (95% confidence interval [Cl] 42% to 81%). The estimated specificity was 78%. For each patient with tuberculosis who was detected by the RIPT protocol, 624 patients were screened at triage, 130 chest radiographs were taken, and 22 patients were placed in respiratory isolation in the ED. Patients with undetected pulmonary tuberculosis more commonly had nonpulmonary chief complaints (76% versus 20%; odds ratio [OR] 13, 95% Cl 2.1 to 78.3), and only 60% (95% Cl 26% to 88%) were ultimately isolated in the hospital. Among RIPT screen-positive patients, radiographic findings predictive of pulmonary tuberculosis were cavitary lesions (OR 84.3, 95% Cl 22.6 to 315), upper lobe infiltrates (OR 24.2, 95% Cl 9.1 to 64.4), pleural effusions (OR 8.9, 95% Cl 2.5 to 31.8), diffuse/interstitial infiltrates (OR 5.7, 95% Cl 1.8 to 17.9), and non-upper lobe infiltrates (OR 3.1, 95% Cl 1.0 to 9.5). Conclusion: The RIPT screening protocol was only moderately sensitive for isolating patients with pulmonary tuberculosis at ED triage. Future studies should evaluate modified and abridged screening protocols, as well as the cost-effectiveness of triage screening.

AB - Study objectives: To investigate the ability of an emergency department screening protocol to initiate respiratory isolation of patients with pulmonary tuberculosis at ED triage before chest radiography. Methods: We conducted a prospective cohort study with retrospective medical record review of adult patients who presented for care to an urban, university-affiliated hospital in Los Angeles County over a 4-month period. Ambulatory patients were administered a triage screening protocol that used patient-reported tuberculosis risk factors and symptoms in combination with selective chest radiography to screen patients at ED triage for active pulmonary tuberculosis. Results: A total of 10,674 patients were screened; 2,218 were isolated at triage and underwent chest radiography, and 378 were kept in isolation in the ED. The respiratory isolation of pulmonary tuberculosis (RIPT) protocol detected 17 of 27 visits made by patients with unsuspected pulmonary tuberculosis, yielding a sensitivity of 63% (95% confidence interval [Cl] 42% to 81%). The estimated specificity was 78%. For each patient with tuberculosis who was detected by the RIPT protocol, 624 patients were screened at triage, 130 chest radiographs were taken, and 22 patients were placed in respiratory isolation in the ED. Patients with undetected pulmonary tuberculosis more commonly had nonpulmonary chief complaints (76% versus 20%; odds ratio [OR] 13, 95% Cl 2.1 to 78.3), and only 60% (95% Cl 26% to 88%) were ultimately isolated in the hospital. Among RIPT screen-positive patients, radiographic findings predictive of pulmonary tuberculosis were cavitary lesions (OR 84.3, 95% Cl 22.6 to 315), upper lobe infiltrates (OR 24.2, 95% Cl 9.1 to 64.4), pleural effusions (OR 8.9, 95% Cl 2.5 to 31.8), diffuse/interstitial infiltrates (OR 5.7, 95% Cl 1.8 to 17.9), and non-upper lobe infiltrates (OR 3.1, 95% Cl 1.0 to 9.5). Conclusion: The RIPT screening protocol was only moderately sensitive for isolating patients with pulmonary tuberculosis at ED triage. Future studies should evaluate modified and abridged screening protocols, as well as the cost-effectiveness of triage screening.

UR - http://www.scopus.com/inward/record.url?scp=0033900820&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033900820&partnerID=8YFLogxK

M3 - Article

C2 - 10736118

AN - SCOPUS:0033900820

VL - 35

SP - 327

EP - 336

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

SN - 0196-0644

IS - 4

ER -