BACKGROUND
Timely pulmonary tuberculosis (PTB) diagnosis is a global health priority for interrupting transmission and optimising treatment outcomes. The dichotomous time-divided approach for time delay has limited clinical application.
OBJECTIVE
We aimed to re-evaluate the time delay based on the PTB disease spectrum using a novel scoring system at the national level in the Republic of Korea.
METHODS
The PTB Spectrum Score (PTBSS) was designed based on previously published proposals for disease spectrum and was validated by mortality. We analysed the data by substituting the PTBSS into the Korea Tuberculosis Cohort Registry, and assessed time delays and related system variables using multivariate regression according to PTBSS.
RESULTS
Among the 14,031 active PTB Korean patients whose data were analysed from 2018 to 2020, patients with active PTB were diagnosed with mild (37.0%), moderate (38.0%), or severe (25.0%) disease status according to the PTBSS. The time delay patterns differed according to the PTBSS. Healthcare delays showed that greater PTB progression was associated with earlier diagnosis. Presentation delay showed a U-shaped pattern of elapsed time with PTB progression, wherein a remarkable presentation delay in the real-world setting might occur at both apical ends: mild and severe PTB. Independent risk factors for severe PTB pattern were age (adjusted OR, 1.014) and male sex (adjusted OR, 1.422), whereas no remarkable risk factor was found for mild PTB.
CONCLUSIONS
Timely pulmonary tuberculosis diagnosis should be accomplished. It could be improved with PTBSS, a simple and intuitive scoring system, and more helpful clinical and public applications rather than the traditional dichotomous time-only approach.