Causes and Predictive Factors Associated with "Diagnosis Changed" Outcomes in Patients Notified as Tuberculosis Cases in a Private Tertiary Hospital.
10.4046/trd.2013.75.6.238
- Author:
Byung Ju KANG
1
;
Kyung Wook JO
;
Tai Sun PARK
;
Jung Wan YOO
;
Sei Won LEE
;
Chang Min CHOI
;
Yeon Mok OH
;
Sang Do LEE
;
Woo Sung KIM
;
Dong Soon KIM
;
Tae Sun SHIM
Author Information
1. Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. shimts@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Nontuberculous Mycobacteria;
Tuberculosis;
Diagnostic Errors;
Incidence
- MeSH:
Crohn Disease;
Diagnostic Errors;
Humans;
Incidence;
Korea;
Logistic Models;
Meningitis;
Nontuberculous Mycobacteria;
Pneumonia;
Tertiary Care Centers*;
Tuberculosis*
- From:Tuberculosis and Respiratory Diseases
2013;75(6):238-243
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: The aim of our study was to evaluate the "diagnosis changed" rate in patients notified as tuberculosis (TB) on the Korean TB surveillance system (KTBS). METHODS: A total of 1,273 patients notified as TB cases on the KTBS in one private tertiary hospital in 2011 were enrolled in the present study. Patients were classified into three groups: "diagnosis maintained", "diagnosis changed" (initially notified as TB, but ultimately diagnosed as non-TB), and "administrative error" (notified as TB due to administrative errors). RESULTS: Excluding 17 patients in the "administrative error" group, the "diagnosis maintained" and "diagnosis changed" groups included 1,097 (87.3%) and 159 patients (12.7%), respectively. Common causes of "diagnosis changed" were nontuberculous mycobacterial (NTM) disease (51.7%, 61/118), and pneumonia (17.8%) in cases notified as pulmonary TB, and meningitis (19.5%, 8/41) and Crohn's disease (12.2%) in cases notified as extrapulmonary TB. Being older than 35 years of age (odds ratio [OR], 2.18) and a positive acid-fast bacilli stain (OR, 1.58) were positive predictors and a TB-related radiological finding (OR, 0.42) was a negative predictor for a "diagnosis changed" result via multivariate logistic regression analysis in pulmonary TB cases. CONCLUSION: Because of a high "diagnosis changed" rate in TB notifications to the KTBS, the TB incidence rate measured by the KTBS may be overestimated. Considering the worldwide trend toward increased NTM disease, the "diagnosis changed" rate may increase over time. Thus, when reporting the annual TB notification rate in Korea, the exclusion of "diagnosis changed" cases is desirable.
