2001 - Tuberculosis in an Acute General Hospital: A retrospective Survey for the year 1996
Dr. Tong Wing Lok, Princess Margaret Hospital
Background
Tuberculosis remains a global concern. In Hong Kong, more than 80% of all TB patients were under the care of outpatient Chest Clinic, TB and Chest Service. The notification rate was rising slowly since 1996. The information of in-hospital management of TB patients, including notification, co-morbidities and mortality among TB patients in both public hospitals and private health sectors was lacking.
Objectives
1. To examine patients' characteristics, disease pattern and TB management in those patients diagnosed of TB,
2. to evaluate notification practice and notification rate, and
3. to study the incidence of comorbidities and mortality in TB patients in the setting of an acute general hospital.
Methods
This was a retrospective study on 233 adult patients diagnosed of TB disease form 1 January 1996 to 31 December 1996 in Princess Margaret Hospital. These 233 patients were derived from 5 main sources: 1) Hospital Record Office, 2) Department of Microbiology, 3) Department of Pathology, 4) Department of Pharmacy and 5) Consultation records to the respiratory team. Their notification status was crosschecked with the TB notification data file from 1995 to 1997 in Statistics Unit. Information of patients' demographic data and disease category, site and extent of disease, mode of diagnosis, treatment details and practice of notification, follow-up, and co-morbidities and mortality data were entered into a standardized data sheet. Demographic data and disease characteristics between patients not notified to DH and notified patients were compared by χ2or t-test.
Results
152 male and 81 female TB patients with a mean age of 55.1± 21.8 years old were seen in 1996. The ratio of pulmonary disease to extrapulmonary disease to pulmonary disease with extrapulmonary involvement was about 5 :4 :1. Most of the patients had co-morbid medical illnesses. Ischaemic and hypertensive heart disease; and chronic obstructive lung disease were the most frequently associated comorbidities in patients with newly diagnosed TB. Diabetes mellitus, renal disease and psychiatric illnesses were also common in our patients. The mortality rate among our TB patients were 20.2%. 111 patients (47.6%) failed to be notified to the Statistics Unit. When compared with notified patients, patients not notified to DH were older (48.6±22.6 vs 61.9±18.7) and had higher mortality rate (7.2% vs 33.5%) (p < 0.05).
Conclusion
TB notification practice in acute general hospital still has room for improvement by cooperation among different departments in the hospital. Under-notification of in-hospital diagnosed TB patients remains a serious problem. Together with 'mysterious' notification rate in private sectors, the problem of under-reporting in PMH may just represent the tip of an iceberg. Similar study should be performed in other acute general hospitals. Together with measures to monitor the treatment of tuberculosis in private sectors may improve overall TB control in Hong Kong.
