P150 Can we be more specific about targets for starting tuberculosis treatment?. (11th November 2022)

• Record Type: Journal Article
• Authors: Gorsuch, TT; Brij, SO
• Is Part Of: Thorax. Volume 77(2022)Supplement 1
• Page Start: A163
• Page End: A163
• Publication Date: 2022-11-11
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thorax-2022-BTSabstracts.285
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Introduction: NICE NG33 (Tuberculosis) specifies that those with imaging suspicious for pulmonary tuberculosis (pTB) should be assessed by the TB team within 1 working day, but does not specify standards for starting treatment. Methodology: All our referrals are entered onto the Tuberculosis Pathway (TBP). This database enables staff to track referrals, ensuring prompt diagnosis or exclusion of TB. Referrals are divided into 'High', 'Medium' or 'Low' priority, according to the urgency of the suspected condition: 'High' for those with suspected infectious pTB or CNS disease, 'Medium' for those with suspected non-infectious pTB, and 'Low' for all others. Start Date is defined as the date of referral; End Date is defined as the date TB treatment is started, TB is excluded ('NotTB'), the patient is stepped down to 'Watch and Wait' or declared lost to follow-up. The difference between start and end date is the Pathway Duration (PD); the PD target for 'High' referrals is ≤7d, for 'Medium' referrals is ≤31d, and for 'Low' referrals is ≤91d. All referrals 2018–2020 were analysed. P values were calculated using Chi-square or Mann Whitney U test. Results: We received 452 referrals 2018–2020 ( table 1 ). Of the 54 'High' patients, median PD was 1d for those with TB and 4d for 'NotTB', p<0.05. 37/39 (94.9%) with TB had PD within target (≤7d), while 8/10 (80%) 'NotTB' were within target (≤7d). Of the 129 'Medium' patients, 62 (48%) had TB (median PD 10d). 40 achieved the PD target of ≤31d (64.5%); 7 (11.3%) had PD >91d. Of the 269 'Low' referrals, 198 had TB, of whom 177 (89.4%) achieved PD of ≤91d. No 'NotTB' subsequently developed TB, but one patient on 'Watch and wait' was subsequently diagnosed with TB. Surprisingly, use of Xpert did not shorten PD for suspected infectious pTB referrals (Xpert: median 1d, IQR 1–3d; NoXpert median 1d, IQR 0–4d; Mann Whitney U test p 0.73). Conclusion: ≤7d is an achievable target to start treatment or exclude TB for the most urgent referrals, but Xpert may not reliably shorten time to diagnosis. It takes longer to rule out TB than to rule it in.