TWELVE HOUR OBSERVATION UNIT DIAGNOSIS OF TUBERCULOSIS

这个项目的广泛和长期目标是改善分配 为患者提供稀缺的结核病(TB)隔离床位 医院急诊科(ED)怀疑有结核病。通过提供一个 痰中抗酸杆菌(AFB)阳性或阳性的准确分类 如果教育署的结核病呈阴性，我们会降低建造成本和 管理住院隔离床位，并降低风险 医护人员(HCW)和其他患者向结核病传播。我们 假设建议隔离或不隔离后 在急诊部观察单位(EDOU)的12小时相遇是 比常规ED推荐更准确，符合率高 随着住院诊断评估期的延长， 在此期间，患者被保持在结核病隔离状态。第一 具体目的是比较敏感度、特异度、阳性率 直接镜检的预测价值和阴性预测价值 对3份连续采集的痰标本进行AFB检测 12小时的Edou与3个清晨的痰样本 连续住院日，第二个具体目标是确定 在ED获得的标准化临床评估的准确性 考虑病史、危险因素、体检和胸部 X线片对活动性肺病诊断的预测价值 结核病。第三个具体目标是比较灵敏度和特异度 埃尔多斯与住院隔离病房(IPIU)诊断结核病的比较 评估EDOU作为快速识别器的诊断能力 新的结核病病例允许更准确的住院指征和 结核病隔离病床的使用。我们将对获得的自变量进行评估 在Edou中检查哪些与这两种涂抹最密切相关 结核杆菌阳性或培养阳性。我们将进行多元物流 回归数据，以开发用于诊断两种培养的模型 已证实具有传染性的结核病。

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.