Role of Cough Officer Screening in Early Detection of Pulmonary Tuberculosis in Inpatients

咳嗽偵測機制在住院病人早期發現肺結核的角色

10.29806/TM.200608.0003

蔡政宏(Cheng-Hung Tsai)；林慶雄(Ching-Hsiung Lin)；林瑞鳳(Chul-Feng Lin)；劉尊榮(Chun-Eng Liu)；黃美麗(Mei-Li Huang)；溫仁和(Jen-Ho Wen)；蔡偉宏(Woei-Horng Chai)

咳嗽偵測機制 ； 肺結核 ； cough officer screening ； pulmonary tuberculosis PTB

胸腔醫學

21卷4期（2006 / 08 / 01）

321 - 327

英文

背景：為避免院內結核病的傳播，早期診斷與治療是必要的結核病防治策略。本篇研究的目的是評估一套電腦化的咳嗽偵測機制用於早期偵測住院病人是否患有肺結核之可行性。 方法：本院實施一套電腦化的咳嗽偵測機制，從2004年10月到2005年9月，所有住院病人皆納入偵測機制並紀錄咳嗽天數。一旦病人咳嗽5天以上，醫師的電腦醫囑系統會提醒醫師評估這些病人是否需要作肺結核檢查，包括胸部X光、肺結核痰液抹片以及培養。 結果：本篇研究期間共有57,745位住院病人，由咳嗽偵測機制提醒醫師病人已連續咳嗽5天以上的病人數為6,971位(12%)，其中有2,088位(30%)有進行胸部X光及痰液檢查。這當中有18位確診為肺結核，且都是內科住院病人。由疾病管制局肺結核通報資訊系統得知，在此研究期間本院共通報151位住院病人確診肺結核個案。本咳嗽偵測機制的TB發現率為12%(18/151)，而藉由本機制診斷一位肺結核病患平均需花費為新台幣49,865元。 結論：咳嗽偵測機制用於早期肺結核之偵測是有其效益的，致力增加醫師對此機制的實行將會提升TB發現率。說經濟效益而言，內科住院病人是本機制實施之最重要族群。到底住院病人最適當的咳嗽天數以開始啟動本機制是最有效益的仍需更進一步的研究。

Background: In order to avoid the transmission of tuberculosis within the hospital, the early detection and treatment of active cases are fundamental tuberculosis control strategies. The aim of this study was to evaluate a computerized protocol, the so-called cough officer screening, for the early detection of pulmonary tuberculosis in inpatients. Materials and Methods: A computerized cough officer screening protocol was used in Changhua Christian Hospital from Oct 2004 to Sep 2005. All inpatients were enrolled and their cough history recorded. The computerized physician order entry system reminded the doctors to survey those patients who had a cough of more than 5 days in duration. Chest radiography, sputum smears, and cultures were prescribed to determine if patients had active pulmonary tuberculosis. Results: A total of 57,745 inpatients were recruited into this study. The cough officer screening system identified 6,971 (12%) patients with cough duration longer than 5 days. Among them, 2,088 (30%) patients had chest radiography and/or sputum acid-fast smear and culture examinations. Eighteen were diagnosed with active pulmonary tuberculosis, and all were admitted to the medical ward. Based on the TB reporting information system, 151 inpatients were diagnosed with pulmonary tuberculosis during this study period, and the case detection rate using cough officer screening was 12% (18/151). The average cost per case finding was NT$49,865. Conclusions: Cough officer screening is effective in the early detection of active pulmonary tuberculosis in inpatients. Strategies to improve doctors' compliance with this screening system will increase the case finding rate. In terms of cost-effectiveness, the internal medicine department is the most important target for screening. Determining the most appropriate cutoff point for cough duration requires further study.