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Diagnosis and management of TB
P53 Fast Track TB Radiology: A Bit of a Bonsai or a Tree in Bud?
  1. GS Bhat,
  2. F Oyesanya,
  3. J Cleverley,
  4. C Cash,
  5. J Goldring,
  6. I Cropley,
  7. MCI Lipman Royal
  1. Free Hospital, London, London

Abstract

Background Prompt diagnosis is central to effective tuberculosis(TB) management. To minimise clinician related delay, we developed a pathway where imaging suggestive of active TB is flagged for review by specialist radiologists and the TB service at a weekly meeting. If required, the patient is then fast-tracked for clinical assessment by the TB team.

Methods Prospective study of patients referred to our radiology service June 2011–February 2012 with imaging flagged as suspicious of TB. Case management, diagnosis and final outcome were recorded.

Results 68 subjects, median age 45 years (range 1–91), were studied. Of the flagged images, 38 were chest radiographs, 28 CT chest +/– abdomen, 1 CT head and 1 MRI spine. 32 (47%) were reported to be highly suspicious for TB. The remaining 36 (53%) had changes such as apical scarring, pleural effusion and/or mediastinal lymphadenopathy where TB was part of the differential diagnosis. 19 (28%) of the radiological referrals were from Primary Care & 12 (18%) Accident & Emergency (A & E). 59 of 68 (87%) were seen in a TB clinic at a median time from date of imaging to appointment of 13 days (range 1 –100). 18 (31%) had a final diagnosis of active TB. 3 were already on TB treatment, and the remaining 15 started a median 24 days from the time of imaging. Apart from TB, common final diagnoses included bacterial or NTM infection, bronchiectasis and sarcoidosis. 4/19 (21%) of GP and 3/12 (25%) A & E referrals had active TB. Patients not seen in a TB clinic were referred to other clinical services (4 cases – all with significant pathology) or no action taken following specialist review of their imaging (5).

Conclusion The fast track service has a high yield for TB and other significant pathologies. Almost half of the reviews arose following Primary Care or A & E imaging. Prompt specialist imaging review is associated with rapid and appropriate triage to TB and other services. Further work will compare this approach to standard care pathways.

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