The emergency department presentation of patients with active pulmonary tuberculosis

Objective: To determine the clinical presentation of emergency department ( ED) patients with active pulmonary tuberculosis (TB). Methods: This was a r etrospective medical record review of adult patients, identified through in fection 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 posit ive sputum culture were categorized as contagious or noncontagious, using d efined 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 ch est radiograph findings. Results: During the study period, 44 patients with active pulmonary TB made 66 contagious ED visits. Multiple contagious ED v isits 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%), a nd traumatic/orthopedic 12% (95% CI = 5% to 22%). At least one TB risk fact or was identified in 57 (86%; 95% CI% = 76 to 94%) patient visits and at le ast one TB symptom in 51 (77%; 95% CI = 65% to 87%) patient visits. Cough w as 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, homele ssness, HN positivity, hemoptysis, and chest pain. Conclusions: Patients wi th active pulmonary TB may have multiple ED visits, and often have nonpulmo nary 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 diff icult to develop and implement high-yield triage screening criteria.