Turkiye Klinikleri Journal of Anesthesiology Reanimation

.: ORIGINAL RESEARCH
Yoğun Bakımda Akciğer Tüberkülozu: Tanı Konulma Süresi ve Gecikmiş Tanı Nedenleri: Retrospektif Kohort Çalışması
Lung Tuberculosis in Intensive Care Unit, Diagnose Time and Reason of Delayed Diagnose: A Retrospective Cohort Study
Süleyman YILDIRIMa, Engin KIRMIZIGÜLa, Burcu ACAR ÇİNLETİb, Cenk KIRAKLIa
aSağlık Bilimleri Üniversitesi Dr. Suat Seren Göğüs Hastalıkları ve Cerrahisi Eğitim ve Araştırma Hastanesi, İç Hastalıkları ABD, Yoğun Bakım BD, İzmir, Türkiye
bSağlık Bilimleri Üniversitesi Dr. Suat Seren Göğüs Hastalıkları ve Cerrahisi Eğitim ve Araştırma Hastanesi, Nöroloji ABD, Yoğun Bakım BD, İzmir, Türkiye
Turkiye Klinikleri J Anest Reanim. 2022;20(1):9-15
doi: 10.5336/anesthe.2021-86093
Article Language: TR
Full Text
ÖZET
 Amaç: Tüberküloz tanısındaki gecikmeler, hasta kaynaklı ve sağlık sistemi kaynaklı olmak üzere 2 başlık altında değerlendirilmektedir. Tüberküloz tanısında yaşanan gecikmeler sonuçları olumsuz etkilemektedir. Bu çalışmanın amacı, yoğun bakımda tüberküloz tanı konulma süresinin belirlenmesi ve gecikmiş tanı nedenlerinin belirlenmesidir. Gereç ve Yöntemler: Bu çalışma retrospektif bir çalışma olup, Sağlık Bilimleri Üniversitesi Dr. Suat Seren Göğüs Hastalıkları ve Cerrahisi Eğitim ve Araştırma Hastanesi, Yoğun Bakım Ünitesinde yapılmıştır. 1 Ocak 2016-31 Aralık 2019 tarihleri arasında yoğun bakım ünitesine kabul esnasında tüberküloz tanısı olmayan ve yoğun bakıma kabul edildikten sonra tüberküloz tanısı konulan hastalar çalışmaya dâhil edilmiştir. Bulgular: Çalışmaya 31 hasta dâhil edilmiştir. Hasta kaynaklı gecikme ortalama 14 gün, sağlık sistemi kaynaklı gecikme 12,5 gün olarak bulunmuştur. İlk başvurusu hastanemize olan hastalarda ortalama tanı süresi 9 gün iken dış merkezden hastanemize sevk ile gelen hastalarda tanı alma süresi 21 gün olarak saptanmıştır (p=0,005). Hastaların yoğun bakımda tüberküloz tanısı alması ortalama 3,29 gün iken 13 (%42) hasta gecikmiş tanılı olgu olarak tespit edilmiştir. Tüm nedenlere bağlı gelişen yoğun bakım mortalitesi normal tanı alan grupta %77, geç tanı alan grupta %46 olarak bulunmuştur (p=0,69). Sonuç: Tüberküloz önemli bir sağlık sorunu olmaya devam etse de tanı konulma esnasında hasta ve sağlık sistemi kaynaklı gecikmeler yaşanmaktadır. Yoğun bakımda hem hastanın izole edilmesi hem de tedavide oluşabilecek gecikmelerin önlenmesi için tüberküloz konusunda farkındalık oluşturulmalıdır. Yoğun bakımda tüberküloz tanısında gecikmelerin nedenleri hakkında çok merkezli çalışmalara ihtiyaç vardır.

Anahtar Kelimeler: Tüberküloz; yoğun bakım ünitesi; mortalite
ABSTRACT
 Objective: Delays in diagnosis of tuberculosis are examined in 2 categories; patient delay and health care system delay. Delay in tuberculosis diagnosis causes worse clinical outcomes. The aims of this study are to determine the time of tuberculosis diagnosis and to evaluate reason for delayed diagnose in intensive care unit. Material and Methods: This is a retrospective study is carried out in Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital Intensive Care Unit. Patients who were newly diagnosed with pulmonary tuberculosis in intensive care unit between 1 January 2016 and 31 December 2019 were included the study. Results: Thirty-one patients were included the study. The average patient delay was found 14 days and the average health care system delay was 12.5 days. The diagnosis time was 9 days in patients who were admitted in our hospital at the beginning and the diagnosis time was 21 days in patients referred our hospital from another center (p=0.005). The average tuberculosis diagnosis time was 3.29 days in ICU and 13 patients (42%) were identified as a delayed diagnosis. Intensive care unit mortality due to all causes was 77% in the normal diagnosis group and 46% in the delayed diagnosis group (p=0.69). Conclusion: Although tuberculosis continues to be an important health problem, there are delays in diagnosis due to the patient and the health care system. To prevent delays in isolation and treatment in intensive care unit patients, awareness should be raised about tuberculosis. There is a need for multicenter studies on the causes of delays in the diagnosis of tuberculosis in intensive care unit.

Keywords: Tuberculosis; intensive care unit; mortality
REFERENCES:
  1. World Health Organization. Global Tuberculosis Report 2019. Geneva: World Health Organization; 2019. p.1, 2. [Link] 
  2. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. Türkiye'de Verem Savaşı 2019 Raporu. Ankara: ELSU ORGANİZASYON TURİZM REKLAM SAN. ve TİC. LTD. ŞTİ; 2020. p.12-14. [Link] 
  3. Ward HA, Marciniuk DD, Pahwa P, Hoeppner VH. Extent of pulmonary tuberculosis in patients diagnosed by active compared to passive case finding. Int J Tuberc Lung Dis. 2004;8(5):593-7. [PubMed] 
  4. Lin HP, Deng CY, Chou P. Diagnosis and treatment delay among pulmonary tuberculosis patients identified using the Taiwan reporting enquiry system, 2002-2006. BMC Public Health. 2009;9:55. [Crossref]  [PubMed]  [PMC] 
  5. Lin CY, Lin WR, Chen TC, Lu PL, Huang PM, Tsai ZR, et al. Why is in-hospital diagnosis of pulmonary tuberculosis delayed in southern Taiwan? J Formos Med Assoc. 2010;109(4):269-77. [Crossref]  [PubMed] 
  6. Yimer S, Bjune G, Alene G. Diagnostic and treatment delay among pulmonary tuberculosis patients in Ethiopia: a cross sectional study. BMC Infect Dis. 2005;5:112. [Crossref]  [PubMed]  [PMC] 
  7. Sreeramareddy CT, Panduru KV, Menten J, Van den Ende J. Time delays in diagnosis of pulmonary tuberculosis: a systematic review of literature. BMC Infect Dis. 2009;9:91. [Crossref]  [PubMed]  [PMC] 
  8. Storla DG, Yimer S, Bjune GA. A systematic review of delay in the diagnosis and treatment of tuberculosis. BMC Public Health. 2008;8:15. [Crossref]  [PubMed]  [PMC] 
  9. Cai J, Wang X, Ma A, Wang Q, Han X, Li Y. Factors associated with patient and provider delays for tuberculosis diagnosis and treatment in Asia: a systematic review and meta-analysis. PLoS One. 2015;10(3):e0120088. [Crossref]  [PubMed]  [PMC] 
  10. Hagan G, Nathani N. Clinical review: tuberculosis on the intensive care unit. Crit Care. 2013;17(5):240. [Crossref]  [PubMed]  [PMC] 
  11. T. C. Sağlık Bakanlığı. Tüberküloz Tanı ve Tedavi Rehberi. 2. Baskı. Ankara: Artı6 Medya Tanıtım Matbaa Ltd. Şti.; 2019. [Link] 
  12. Han J, Nam BD, Park SY, Park J, Lee E, Lee EJ, et al. Risk factors for delayed ısolation of patients with active pulmonary tuberculosis in an acute-care hospital. Sci Rep. 2019;9(1):4849. [Crossref]  [PubMed]  [PMC] 
  13. Xu X, Liu JH, Cao SY, Zhao Y, Dong XX, Liang Y, et al. Delays in care seeking, diagnosis and treatment among pulmonary tuberculosis patients in Shenzhen, China. Int J Tuberc Lung Dis. 2013;17(5):615-20. [Crossref]  [PubMed] 
  14. Farah MG, Rygh JH, Steen TW, Selmer R, Heldal E, Bjune G. Patient and health care system delays in the start of tuberculosis treatment inNorway. BMC Infect Dis. 2006;6:33. [Crossref]  [PubMed]  [PMC] 
  15. Tamhane A, Ambe G, Vermund SH, Kohler CL, Karande A, Sathiakumar N. Pulmonary tuberculosis in mumbai, India: factors responsible for patient and treatment delays. Int J Prev Med. 2012;3(8):569-80. [PubMed]  [PMC] 
  16. Güneylioglu D, Yilmaz A, Bilgin S, Bayram U, Akkaya E. Factors affecting delays in diagnosis and treatment of pulmonary tuberculosis in a tertiary care hospital in Istanbul, Turkey. Med Sci Monit. 2004;10(2):CR62-7. [PubMed] 
  17. Çalışır HC, Yurdakul AS, Öğretensoy M. Tüberküloz kontrolünde hasta ve doktor gecikmesi [Patient and doctor delay in tuberculosis control]. Tüberküloz ve Toraks Dergisi. 2001;49(2):252-8. [Link] 
  18. Pirkis JE, Speed BR, Yung AP, Dunt DR, MacIntyre CR, Plant AJ. Time to initiation of anti-tuberculosis treatment. Tuber Lung Dis. 1996;77(5):401-6. [Crossref]  [PubMed] 
  19. Lewinsohn DM, Leonard MK, LoBue PA, Cohn DL, Daley CL, Desmond E, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for disease control and prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017;64(2):111-5. [Crossref]  [PubMed]  [PMC] 
  20. Byrd RP Jr, Mehta JB, Roy TM. Delay in diagnosis among hospitalized patients with active tuberculosis--predictors and outcomes. Am J Respir Crit Care Med. 2003;167(2):278; author reply 278. [Crossref]  [PubMed] 
  21. Tatar D, Senol G, Kirakli C, Edipoglu O, Cimen P. Contributing factors to mortality rates of pulmonary tuberculosis in intensive care units. J Chin Med Assoc. 2018;81(7):605-10. [Crossref]  [PubMed] 
  22. Zahar JR, Azoulay E, Klement E, De Lassence A, Lucet JC, Regnier B, et al. Delayed treatment contributes to mortality in ICU patients with severe active pulmonary tuberculosis and acute respiratory failure. Intensive Care Med. 2001;27(3):513-20. [Crossref]  [PubMed]  [PMC] 
  23. Hosoglu S, Tanrikulu AC, Dagli C, Akalin S. Tuberculosis among health care workers in a short working period. Am J Infect Control. 2005;33(1):23-6. [Crossref]  [PubMed] 
  24. Kılınç O, Uçan ES, Çakan A, Ellidokuz H, Özol D, Sayıner A, et al. İzmir'de sağlık çalışanları arasında tüberküloz hastalığı riski: tüberküloz meslek hastalığı olarak kabul edilebilir mi [Risk of tuberculous disease among health care workers in İzmir: can tuberculosis be considered as an occupational disease]. Toraks Dergisi. 2000;1(1):19-24. [Link] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com