A systematic review of delay in the diagnosis and treatment of tuberculosis.
A systematic review of delay in the diagnosis and treatment of tuberculosis.
复制标题
对结核病诊断和治疗的延迟进行系统的综述。
DOI：
10.1186/1471-2458-8-15
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发表时间：
2008-01-14
影响因子：
4.5
通讯作者：
Bjune, Gunnar Aksel
中科院分区：
文献类型：
--
作者：
Storla, Dag Gundersen;Yimer, Solomon;Bjune, Gunnar Aksel
早期诊断和立即开始治疗对于有效的结核病（TB）控制计划至关重要。延误诊断对个体水平的疾病预后和社区内的传播都有重要意义。大多数传播发生在咳嗽发作和开始治疗之间。对58项关于结核病诊断和治疗延迟的研究进行了系统评价。我们发现不同的定义，例如，首次出现的症状，第一个适当的医疗保健提供者，诊断时间，开始治疗。我们没有排除那些不符合严格科学标准的研究（如荟萃分析），而是试图从所有这些研究中提取“可靠的发现”，以更全面地了解结核病的诊断延迟。与诊断延迟相关的主要因素包括人类免疫缺陷病毒;慢性咳嗽和/或其他肺部疾病的共存;痰涂片阴性;肺外结核;农村居住;低获得性（地理或社会心理障碍）;初次访问政府低级医疗机构、私人开业医生或传统治疗师;老年;贫困;女性;酗酒和药物滥用;移民史;教育水平低;对结核病认识不足;不全面的信念;自我治疗;和耻辱。延误诊断和治疗的核心问题似乎是在同一医疗水平重复就诊的恶性循环，导致非特异性抗生素治疗和无法获得专门的结核病服务。一旦达到特定诊断的生成，在合理的时间内开始TB治疗。
Early diagnosis and immediate initiation of treatment are essential for an effective tuberculosis (TB) control program. Delay in diagnosis is significant to both disease prognosis at the individual level and transmission within the community. Most transmissions occur between the onset of cough and initiation of treatment. A systematic review of 58 studies addressing delay in diagnosis and treatment of TB was performed. We found different definitions of, for example, debut of symptoms, first appropriate health care provider, time to diagnosis, and start of treatment. Rather than excluding studies that failed to meet strict scientific criteria (like in a meta-analysis), we tried to extract the "solid findings" from all of them to arrive on a more global understanding of diagnostic delay in TB. The main factors associated with diagnostic delay included human immunodeficiency virus; coexistence of chronic cough and/or other lung diseases; negative sputum smear; extrapulmonary TB; rural residence; low access (geographical or sociopsychological barriers); initial visitation of a government low-level healthcare facility, private practitioner, or traditional healer; old age; poverty; female sex; alcoholism and substance abuse; history of immigration; low educational level; low awareness of TB; incomprehensive beliefs; self-treatment; and stigma. The core problem in delay of diagnosis and treatment seemed to be a vicious cycle of repeated visits at the same healthcare level, resulting in nonspecific antibiotic treatment and failure to access specialized TB services. Once generation of a specific diagnosis was in reach, TB treatment was initiated within a reasonable period of time.
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影响因子：
120.7
作者：
Dye, C;Scheele, S;Raviglione, RC
通讯作者：
Raviglione, RC
影响因子：
4.5
作者：
Kiwuwa MS;Charles K;Harriet MK
通讯作者：
Harriet MK
DOI：
10.1164/ajrccm.157.4.9709071
发表时间：
1998-04-01
影响因子：
24.7
作者：
Asch, S;Leake, B;Gelberg, L
通讯作者：
Gelberg, L
DOI：
10.1016/0962-8479(92)90091-w
发表时间：
1992-08-01
期刊：
TUBERCLE AND LUNG DISEASE
影响因子：
--
作者：
MORI, T;SHIMAO, T;KIM, SJ
通讯作者：
KIM, SJ
影响因子：
3.7
作者：
Farah MG;Rygh JH;Steen TW;Selmer R;Heldal E;Bjune G
通讯作者：
Bjune G