S. Asch et al., TUBERCULOSIS IN HOMELESS PATIENTS - POTENTIAL FOR CASE-FINDING IN PUBLIC EMERGENCY DEPARTMENTS, Annals of emergency medicine, 32(2), 1998, pp. 144-147
Study objectives: Previous studies have had difficulty evaluating the
optimal clinical site for screening homeless patients for active tuber
culosis (TB). We hypothesized that homeless patients with TB would not
frequently reside in shelters at the time of their diagnosis and woul
d be more likely than other patients with TB to seek care in public ho
spitals, thus presenting an opportunity for screening radiography. Met
hods: This registry-based survey included 743 consecutive patients wit
h confirmed active TB in Los Angeles County. No therapeutic interventi
on was involved. Results: When compared with patients with TB who were
not homeless, homeless patients with TB were more likely to be male (
93% versus 63%, P < .001), black (44% versus 15%, P < .001), living in
the inner city (55% versus 7%, P < .001), and born in the United Stat
es (67% versus 32%, P < .001). They were more infectious than other pa
tients with TB as evidenced by a trend toward more cavitary radiograph
ic lesions (24% versus 16%, P = .11) and significantly more positive s
putum smears (56% versus 41%, P = .009). Less than a third lived in co
ngregate facilities such as shelters at the time of their diagnosis. I
nstead, their disease was diagnosed more often at county hospitals (54
% versus 23%, P < .001) than patients with TB who were not homeless. C
onclusion: Widespread screening for TB in shelters may miss most homel
ess patients with TB. Because most county-hospital homeless patients w
ith TB initially present to emergency departments and many do not live
in shelters, future cost-effectiveness studies should evaluate chest
radiograph screening for all homeless ED patients.