Introduction Delayed diagnosis of active pulmonary tuberculosis (TB) is common and significantly contributes to transmission especially in smear-positive pulmonary TB. Persons with symptoms suggestive of pulmonary TB often have chest radiographs prior to sputum examination and clinical assessment by a specialist. There is no NICE guidance on direct radiology referral pathways to a rapid access TB clinic. This question prompted us to examine all cases referred by the radiology department to our rapid access TB clinic at a centre of England tertiary referral centre.
Method We conducted a retrospective study of consecutive patients with features of active TB on chest radiograph referred by the radiologists to the rapid access TB clinic from 2008 to 2013. All chest radiographs were reviewed by TB consultants who arranged clinic appointments according to the degree of clinical suspicion of active disease.
Results 223 cases were referred during the period of November 2008 to May 2013. All patients were requested to attend the TB clinic, 4 patients did not attend clinic.
Of 223 cases, 111 patients (50%) were diagnosed with active TB. Mean age of all active cases was 38 years (range 16–83 years) with a male predominance (62, 56%). Of 111 cases, 61 (55%) were from Indian subcontinent, 22 (19%) from Africa, 25 (22%) were UK born and 3 cases were born in other countries.
80 cases had pulmonary TB (72%), of whom 47 (59%) were smear positive. 28 cases (25%) had extra pulmonary disease, two cases had disseminated miliary disease and one case was diagnosed clinically.
Table 1 indicates that 102 (92%) cases were seen in clinic within 14 days of rapid access radiology referral and 80 (72%) were started on anti-TB treatment within 28 days of radiology referral. 103 patients (93%) had fully sensitive TB with 8 resistant cases.
Conclusion Direct radiology referral of cases with chest radiographs suggestive of pulmonary TB to a rapid access TB clinic can hasten diagnosis of active TB and should be included in NICE guidance.
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