DELAYED RECOGNITION AND INFECTION-CONTROL FOR TUBERCULOSIS PATIENTS IN THE EMERGENCY DEPARTMENT

Study objective: The recent increase in tuberculosis (TB) cases may ha ve an important effect on emergency department infection-control measu res. We describe infection-control interventions for TB patients admit ted through the ED and hypothesize that ED suspicion of TB is associat ed with more rapid isolation and treatment. Design: Retrospective char t review. Setting: The ED of a 400-bed urban, university-affiliated co unty hospital. Participants: Fifty-five patients with TB culture-posit ive and acid-fast bacillus stain-positive respiratory specimens who we re evaluated in the ED during 1991 and 1992. Results: We identified ca ses from the mycobacteriology log. Demographic and historical data and time elapsed before initiation of infection-control measures and TB t herapy were recorded. We assessed the relationships of individual clin ical findings and the ED presumptive diagnosis of TB (predictor variab les) to time elapsed before isolation and therapy (outcome variables) with the lag-rank test. The median time (interquartile range) from ED registration to isolation was 8 hours (range, 3 to 13 hours). An ED pr esumptive diagnosis of TB was made in 71% of cases and was significant ly associated with shorter time elapsed before isolation (5 hours [ran ge, 2 to 10 hours] versus 21 hours [range, 11 to 111 hours]; P<.001) a nd less time elapsed before therapy(l2 hours [range, 9 to 22 hours] ve rsus 128 hours [68 to 374 hours]; P<.001). We found TB exposure, radio graphic changes typical of TB, absence of HIV risk factors, presence o f cough, and sputum production to be associated with more rapid isolat ion. Conclusion: Among patients with active pulmonary TB in the ED, TB is often unsuspected and isolation measures are often not used. ED su spicion of TB is associated with more rapid isolation and treatment.