TWELVE HOUR OBSERVATION UNIT DIAGNOSIS OF TUBERCULOSIS

该项目的广泛和长期目标是改善分配 稀缺的结核病（TB）隔离病床，用于那些出现结核病症状的患者。 医院急诊科（艾德）疑似TB。通过提供 痰液抗酸杆菌（AFB）阳性或 艾德的结核病阴性，我们将降低建设成本， 管理医院隔离病床单位，并降低风险， 卫生保健工作者（HCWs）和其他患者的结核病传播。我们 我假设，隔离或不隔离的建议后， 在急诊室观察室（EDOU）的12小时会面是 比常规艾德推荐更准确，一致性高 随着住院诊断评估期的延长， 在此期间，患者保持结核病隔离。 第一 具体目的是比较敏感性、特异性、阳性 直接镜检的预测值和阴性预测值 对在以下时间内获得的3份连续痰液样本进行AFB检测 在EDOU中12小时与在EDOU中获得的3份清晨痰液样本相比， 第二个具体目标是确定 在艾德获得的标准化临床评估的准确性， 考虑患者病史、风险因素、体格检查和胸部 X线平片在预测活动性肺动脉高压诊断中的价值 TB. 第三个具体目的是比较敏感性和特异性 EDOU与住院隔离病房（IPIU）中结核病诊断的比例 评估EDOU作为快速识别器的诊断能力， 新的结核病例允许更精确的住院指征， 使用结核病隔离床。我们将评估获得的独立变量 在EDOU中检查哪些与涂片最密切相关， 阳性或培养阳性结核病。 我们将进行多元逻辑分析 回归数据，以开发用于诊断两种文化的模型 被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.