The emergency department presentation of patients with active pulmonary tuberculosis

P. E. Sokolove, L. Rossman, Stuart H Cohen

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Objective: To determine the clinical presentation of emergency department (ED) patients with active pulmonary tuberculosis (TB). Methods: This was a retrospective medical record review of adult patients, identified through infection control records, diagnosed as having active pulmonary TB by sputum culture over a 30-month period at an urban teaching hospital. The ED visits by these patients from one year before to one year after the initial positive sputum culture were categorized as contagious or noncontagious, using defined clinical and radiographic criteria. The medical records of patients with contagious visits to the ED were reviewed to determine chief complaint, presence of TB risk factors and symptoms, and physical examination and chest radiograph findings. Results: During the study period, 44 patients with active pulmonary TB made 66 contagious ED visits. Multiple contagious ED visits were made by 12 patients (27%; 95% CI = 15% to 43%). Chief complaints were pulmonary 33% (95% CI = 22% to 46%), medical but nonpulmonary 41% (95% CI = 29% to 54%), infectious but nonpulmonary 14% (95% CI = 6% to 24%), and traumatic/orthopedic 12% (95% CI = 5% to 22%). At least one TB risk factor was identified in 57 (86%; 95% CI% = 76 to 94%) patient visits and at least one TB symptom in 51 (77%; 95% CI = 65% to 87%) patient visits. Cough was present during only 64% (95% CI = 51% to 75%) of the patient visits and hemoptysis during 8% (95% CI = 3% to 17%). Risk factors and symptoms that, if present, were likely to be detected at triage were foreign birth, homelessness, HIV positivity, hemoptysis, and chest pain. Conclusions: Patients with active pulmonary TB may have multiple ED visits, and often have nonpulmonary complaints. Tuberculosis risk factors and symptoms are usually present in these patients but often missed at ED triage. The diversity of clinical presentations among ED patients with pulmonary TB will likely make it difficult to develop and implement high-yield triage screening criteria.

Original languageEnglish (US)
Pages (from-to)1056-1060
Number of pages5
JournalAcademic Emergency Medicine
Volume7
Issue number9
StatePublished - 2000

Fingerprint

Pulmonary Tuberculosis
Hospital Emergency Service
Triage
Tuberculosis
Hemoptysis
Sputum
Medical Records
Homeless Persons
Urban Hospitals
Infection Control
Chest Pain
Cough
Teaching Hospitals
Physical Examination
Orthopedics
Thorax
HIV
Parturition
Lung

Keywords

  • Emergency department
  • Symptoms
  • Triage
  • Tuberculosis

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

The emergency department presentation of patients with active pulmonary tuberculosis. / Sokolove, P. E.; Rossman, L.; Cohen, Stuart H.

In: Academic Emergency Medicine, Vol. 7, No. 9, 2000, p. 1056-1060.

Research output: Contribution to journalArticle

@article{58dcbf4c3e91461e9637add7beb17d80,
title = "The emergency department presentation of patients with active pulmonary tuberculosis",
abstract = "Objective: To determine the clinical presentation of emergency department (ED) patients with active pulmonary tuberculosis (TB). Methods: This was a retrospective medical record review of adult patients, identified through infection control records, diagnosed as having active pulmonary TB by sputum culture over a 30-month period at an urban teaching hospital. The ED visits by these patients from one year before to one year after the initial positive sputum culture were categorized as contagious or noncontagious, using defined clinical and radiographic criteria. The medical records of patients with contagious visits to the ED were reviewed to determine chief complaint, presence of TB risk factors and symptoms, and physical examination and chest radiograph findings. Results: During the study period, 44 patients with active pulmonary TB made 66 contagious ED visits. Multiple contagious ED visits were made by 12 patients (27{\%}; 95{\%} CI = 15{\%} to 43{\%}). Chief complaints were pulmonary 33{\%} (95{\%} CI = 22{\%} to 46{\%}), medical but nonpulmonary 41{\%} (95{\%} CI = 29{\%} to 54{\%}), infectious but nonpulmonary 14{\%} (95{\%} CI = 6{\%} to 24{\%}), and traumatic/orthopedic 12{\%} (95{\%} CI = 5{\%} to 22{\%}). At least one TB risk factor was identified in 57 (86{\%}; 95{\%} CI{\%} = 76 to 94{\%}) patient visits and at least one TB symptom in 51 (77{\%}; 95{\%} CI = 65{\%} to 87{\%}) patient visits. Cough was present during only 64{\%} (95{\%} CI = 51{\%} to 75{\%}) of the patient visits and hemoptysis during 8{\%} (95{\%} CI = 3{\%} to 17{\%}). Risk factors and symptoms that, if present, were likely to be detected at triage were foreign birth, homelessness, HIV positivity, hemoptysis, and chest pain. Conclusions: Patients with active pulmonary TB may have multiple ED visits, and often have nonpulmonary complaints. Tuberculosis risk factors and symptoms are usually present in these patients but often missed at ED triage. The diversity of clinical presentations among ED patients with pulmonary TB will likely make it difficult to develop and implement high-yield triage screening criteria.",
keywords = "Emergency department, Symptoms, Triage, Tuberculosis",
author = "Sokolove, {P. E.} and L. Rossman and Cohen, {Stuart H}",
year = "2000",
language = "English (US)",
volume = "7",
pages = "1056--1060",
journal = "Academic Emergency Medicine",
issn = "1069-6563",
publisher = "Wiley-Blackwell",
number = "9",

}

TY - JOUR

T1 - The emergency department presentation of patients with active pulmonary tuberculosis

AU - Sokolove, P. E.

AU - Rossman, L.

AU - Cohen, Stuart H

PY - 2000

Y1 - 2000

N2 - Objective: To determine the clinical presentation of emergency department (ED) patients with active pulmonary tuberculosis (TB). Methods: This was a retrospective medical record review of adult patients, identified through infection control records, diagnosed as having active pulmonary TB by sputum culture over a 30-month period at an urban teaching hospital. The ED visits by these patients from one year before to one year after the initial positive sputum culture were categorized as contagious or noncontagious, using defined clinical and radiographic criteria. The medical records of patients with contagious visits to the ED were reviewed to determine chief complaint, presence of TB risk factors and symptoms, and physical examination and chest radiograph findings. Results: During the study period, 44 patients with active pulmonary TB made 66 contagious ED visits. Multiple contagious ED visits were made by 12 patients (27%; 95% CI = 15% to 43%). Chief complaints were pulmonary 33% (95% CI = 22% to 46%), medical but nonpulmonary 41% (95% CI = 29% to 54%), infectious but nonpulmonary 14% (95% CI = 6% to 24%), and traumatic/orthopedic 12% (95% CI = 5% to 22%). At least one TB risk factor was identified in 57 (86%; 95% CI% = 76 to 94%) patient visits and at least one TB symptom in 51 (77%; 95% CI = 65% to 87%) patient visits. Cough was present during only 64% (95% CI = 51% to 75%) of the patient visits and hemoptysis during 8% (95% CI = 3% to 17%). Risk factors and symptoms that, if present, were likely to be detected at triage were foreign birth, homelessness, HIV positivity, hemoptysis, and chest pain. Conclusions: Patients with active pulmonary TB may have multiple ED visits, and often have nonpulmonary complaints. Tuberculosis risk factors and symptoms are usually present in these patients but often missed at ED triage. The diversity of clinical presentations among ED patients with pulmonary TB will likely make it difficult to develop and implement high-yield triage screening criteria.

AB - Objective: To determine the clinical presentation of emergency department (ED) patients with active pulmonary tuberculosis (TB). Methods: This was a retrospective medical record review of adult patients, identified through infection control records, diagnosed as having active pulmonary TB by sputum culture over a 30-month period at an urban teaching hospital. The ED visits by these patients from one year before to one year after the initial positive sputum culture were categorized as contagious or noncontagious, using defined clinical and radiographic criteria. The medical records of patients with contagious visits to the ED were reviewed to determine chief complaint, presence of TB risk factors and symptoms, and physical examination and chest radiograph findings. Results: During the study period, 44 patients with active pulmonary TB made 66 contagious ED visits. Multiple contagious ED visits were made by 12 patients (27%; 95% CI = 15% to 43%). Chief complaints were pulmonary 33% (95% CI = 22% to 46%), medical but nonpulmonary 41% (95% CI = 29% to 54%), infectious but nonpulmonary 14% (95% CI = 6% to 24%), and traumatic/orthopedic 12% (95% CI = 5% to 22%). At least one TB risk factor was identified in 57 (86%; 95% CI% = 76 to 94%) patient visits and at least one TB symptom in 51 (77%; 95% CI = 65% to 87%) patient visits. Cough was present during only 64% (95% CI = 51% to 75%) of the patient visits and hemoptysis during 8% (95% CI = 3% to 17%). Risk factors and symptoms that, if present, were likely to be detected at triage were foreign birth, homelessness, HIV positivity, hemoptysis, and chest pain. Conclusions: Patients with active pulmonary TB may have multiple ED visits, and often have nonpulmonary complaints. Tuberculosis risk factors and symptoms are usually present in these patients but often missed at ED triage. The diversity of clinical presentations among ED patients with pulmonary TB will likely make it difficult to develop and implement high-yield triage screening criteria.

KW - Emergency department

KW - Symptoms

KW - Triage

KW - Tuberculosis

UR - http://www.scopus.com/inward/record.url?scp=0033816908&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033816908&partnerID=8YFLogxK

M3 - Article

C2 - 11044004

AN - SCOPUS:0033816908

VL - 7

SP - 1056

EP - 1060

JO - Academic Emergency Medicine

JF - Academic Emergency Medicine

SN - 1069-6563

IS - 9

ER -