The Accuracy of Emergency Physicians' Suspicions of Active Pulmonary Tuberculosis

Objective To investigate factors associated with recognition and delayed isolation of pulmonary tuberculosis (PTB). Background Precise identification of PTB in the emergency department (ED) remains challenging. Methods Retrospectively reviewed PTB suspects admitted via the ED were divided into three groups based on the acid-fast bacilli culture report and whether they were isolated initially in the ED or general ward. Factors related to recognition and delayed isolation were statistically compared. Results Only 24.94% (100/401) of PTB suspects were truly active PTB and 33.77% (51/151) of active PTB were unrecognized in the ED. Weight loss ( p = 0.022), absence of dyspnea ( p = 0.021), and left upper lobe field ( p = 0.024) lesions on chest radiographs were related to truly active PTB. Malignancy ( p = 0.015), chronic kidney disease ( p = 0.047), absence of a history of PTB ( p = 0.013), and lack of right upper lung ( p ≤ 0.001) and left upper lung ( p = 0.020) lesions were associated with PTB being missed in the ED. Conclusions Weight loss, absence of dyspnea, and left upper lobe field lesions on chest radiographs were related to truly active PTB. Malignancy, chronic kidney disease, absence of a history of PTB, and absence of right and/or left upper lung lesions on chest radiography were associated with isolation delay.