TWELVE HOUR OBSERVATION UNIT DIAGNOSIS OF TUBERCULOSIS

该项目的广泛、长期目标是改善分配 为就诊患者提供稀缺的结核病隔离床位 医院急诊科 (ED) 疑似结核病患者。通过提供 痰抗酸杆菌（AFB）阳性或阳性的准确分类 急诊室结核病呈阴性，我们将降低建设成本 院内隔离床位管理，降低感染风险 医护人员 (HCW) 和其他患者可能会传播结核病。我们 假设隔离或不隔离的建议 在急诊科观察室 (EDOU) 进行 12 小时的观察 比常规ED推荐更准确，一致性高 住院诊断评估期延长的比率， 在此期间，患者处于结核病隔离状态。 第一个 具体目的是比较敏感性、特异性、阳性率 直接镜检预测值和阴性预测值 对 3 年内获得的连续痰样本进行 AFB 检测 12 小时的 EDOU 对比 3 个清晨痰样本 连续住院天数，第二个具体目标是确定 在急诊室获得的标准化临床评估的准确性 考虑患者病史、危险因素、体检和胸部检查 就诊时的放射线照片可预测活动性肺疾病的诊断 结核病。 第三个具体目标是比较敏感性和特异性 EDOU 与住院隔离病房 (IPIU) 中结核病诊断的比较 评估 EDOU 作为快速识别器的诊断能力 新的结核病病例可以提供更准确的住院指示和 使用结核病隔离床。我们将评估获得的自变量 在 EDOU 中检查哪些与任一涂片最密切相关 结核病阳性或培养阳性。 我们将进行多元物流 回归数据以开发两种培养物的诊断模型 已证实的传染性结核病。

The broad, longterm objective of this project is to improve the allocation of scarce tuberculosis (TB) isolation beds for patients who present to a hospital Emergency Department (ED) with suspected TB. By providing an accurate classification of sputum acid-fast bacilli (AFB) positive or negative TB from the ED, we would decrease the costs of construction and management of in-hospital isolation bed units, and decrease the risk to health care workers (HCWs) and other patients to TB transmission. We hypothesize that the recommendation for isolation or no isolation after a 12 hour encounter in an Emergency Department Observation Unit (EDOU) is more accurate than routine ED recommendation, and has high concordance rates with the more prolonged inpatient diagnostic assessment period, during which the patient is maintained in TB isolation. The first specific aim is to compare the sensitivity, specificity, positive predictive value and negative predictive value of direct microscopic detection of AFB when performed on 3 serial sputum samples obtained within 12 hours in an EDOU versus 3 early morning sputum samples obtained during consecutive hospital days, The second specific aim is to determine the accuracy of a standardized clinical assessment obtained in the ED that considers patient history, risk factors, physical exam and chest radiograph at presentation in predicting the diagnosis of active pulmonary TB. The third specific aim is to compare the sensitivity and specificity of the diagnosis of TB in the EDOU versus In-Patient Isolation Unit (IPIU) assessing the diagnostic capability of the EDOU as a rapid identifier of new TB cases allowing more precise indications for hospitalization and the use of TB isolation beds. We will evaluate independent variables obtained in the EDOU to examine which are most closely associated with either smear positive or culture positive TB. We will perform multivariate logistic regression data in order to develop a model for diagnosis of both culture proven and infectious TB.