P54 Impact of a rapid access system for early referral of suspected TB cases

• Published in: Thorax Vol. 66; no. Suppl 4; p. A90
• Main Authors: Verma, R, Lee, J, Haldar, P, Woltmann, G
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Thoracic Society 01.12.2011; BMJ Publishing Group LTD
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thoraxjnl-2011-201054c.54

IntroductionEarly diagnosis and treatment of infectious tuberculosis (TB) is an important strategy for controlling the burden of disease by minimising the spread of infection and secondary disease in close contacts. Since 2005, we have developed a centralised rapid referral system in Leicester for the early assessment of suspected TB by a specialist physician. The system is triggered by a list of “red-flag” symptoms submitted on a proforma and/or appropriate coding by the reporting radiologist of all abnormal chest radiographs compatible with a possible diagnosis of TB.AimsTo evaluate whether differences exist in disease characteristics and time to diagnosis with availability of the rapid referral system.MethodsA retrospective analysis of data collected from patients referred to the Rapid Access TB clinic between the years 2005 and 2010 was conducted. A sub-group analysis was completed for the years 2007–2009 comparing cases referred to the rapid access clinic with those diagnosed by other (non-rapid referral) pathways.Results1552 suspected cases of tuberculosis were referred through the rapid access system, with a positive diagnosis made in 566 (36.5%). Radiological coding of CXR reports was the primary trigger for 93.8% of referrals. No differences existed in age, gender or ethnicity of patients identified through rapid access or other pathways. A significantly higher proportion of cases identified through rapid access were pulmonary (Abstract P54 table 1). The rapid access system was associated with a significant reduction in the time to specialist assessment for both non-pulmonary and smear positive pulmonary TB.Abstract P54 Table 1Summary of sub-group analysis for the years 2007–2009 comparing cases referred to the rapid access clinic with those diagnosed by other (non-rapid referral) pathwaysRapid access (n=288)Other pathways to diagnosis (n=300)Statistical significance (p value; χ2 test)Male gender (%)54.251.2>0.05Mean age (years)36.441.6>0.05Age groups (years) 0–1665>0.05 16–36155145>0.05 >36127150>0.05Ethnicity Indian sub-continent191226>0.05 Black3243>0.05Disease type Non-pulmonary26.448.40.04 Pulmonary smear negative41.616.20.03 Pulmonary smear positive32.035.4>0.05Average duration of symptoms (days) Non-pulmonary78.4122.10.03 Pulmonary smear negative80.4100.1>0.05 Pulmonary smear positive60.295.90.03Contact tracing % Associated with contacts81.690>0.05 Mean number of contacts4.574.91>0.05ConclusionsA rapid access system of referral that incorporates a red-flag coding system of potentially abnormal CXRs effectively identifies a significant proportion of pulmonary TB cases and reduces the time to assessment and treatment of smear positive pulmonary TB.