Affiliation:
1. Department of Economics and Business, Cornell College, Mount Vernon, Iowa
2. Departments of Pharmacy Practice and Science
3. Biostatistics
4. Internal Medicine
5. Epidemiology, University of Iowa, Iowa City
Abstract
Abstract
Background. Delayed diagnosis of tuberculosis (TB) may lead to worse outcomes and additional TB exposures.
Methods. To estimate the potential number of misdiagnosed TB cases, we linked all hospital and emergency department (ED) visits in California′s Healthcare Cost and Utilization Project (HCUP) databases (2005–2011). We defined a potential misdiagnosis as a visit with a new, primary diagnosis of TB preceded by a recent respiratory-related hospitalization or ED visit. Next, we calculated the prevalence of potential missed TB diagnoses for different time windows. We also computed odds ratios (OR) comparing the likelihood of a previous respiratory diagnosis in patients with and without a TB diagnosis, controlling for patient and hospital characteristics. Finally, we determined the correlation between a hospital′s TB volume and the prevalence of potential TB misdiagnoses.
Results. Within 30 days before an initial TB diagnosis, 15.9% of patients (25.7% for 90 days) had a respiratory-related hospitalization or ED visit. Also, within 30 days, prior respiratory-related visits were more common in patients with TB than other patients (OR = 3.83; P < .01), controlling for patient and hospital characteristics. Respiratory diagnosis-related visits were increasingly common until approximately 90 days before the TB diagnosis. Finally, potential misdiagnoses were more common in hospitals with fewer TB cases (ρ = −0.845; P < .01).
Conclusions. Missed opportunities to diagnose TB are common and correlate inversely with the number of TB cases diagnosed at a hospital. Thus, as TB becomes infrequent, delayed diagnoses may increase, initiating outbreaks in communities and hospitals.
Funder
National Heart Lung and Blood Institute at the National Institutes of Health
UI Health Care eHealth and eNovation Center
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Oncology
Cited by
31 articles.
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