Annals of Emergency Medicine
Volume 53, Issue 5 , Pages 625-632, May 2009

Decision Instrument for the Isolation of Pneumonia Patients With Suspected Pulmonary Tuberculosis Admitted Through US Emergency Departments

Presented at the Society for Academic Emergency Medicine, May 1999, Boston, MA.

  • Gregory J. Moran, MD

      Affiliations

    • Department of Medicine, Division of Emergency Medicine, Olive View–University of California–Los Angeles Medical Center, Sylmar, CA
    • Corresponding Author InformationAddress for correspondence: Gregory J. Moran, MD, Department of Emergency Medicine, Olive View-UCLA Medical Center, 14445 Olive View Dr, North Annex, Sylmar, CA 91342; 818-364-3110, fax 818-364-3268
    • ,
  • Tyler W. Barrett, MD

      Affiliations

    • Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
    • ,
  • William R. Mower, MD, PhD

      Affiliations

    • Department of Medicine, Division of Emergency Medicine, UCLA Emergency Medicine Center, Los Angeles, CA
    • ,
  • Anusha Krishnadasan, PhD

      Affiliations

    • Department of Medicine, Division of Emergency Medicine, Olive View–University of California–Los Angeles Medical Center, Sylmar, CA
    • ,
  • Fredrick M. Abrahamian, DO

      Affiliations

    • Department of Medicine, Division of Emergency Medicine, Olive View–University of California–Los Angeles Medical Center, Sylmar, CA
    • ,
  • Samuel Ong, MD

      Affiliations

    • Department of Medicine, Division of Emergency Medicine, Olive View–University of California–Los Angeles Medical Center, Sylmar, CA
    • ,
  • Janet Y. Nakase, MPH

      Affiliations

    • Department of Medicine, Division of Emergency Medicine, Olive View–University of California–Los Angeles Medical Center, Sylmar, CA
    • ,
  • Robert W. Pinner, MD

      Affiliations

    • Centers for Disease Control and Prevention, Atlanta, GA
    • ,
  • Matthew J. Kuehnert, MD

      Affiliations

    • Centers for Disease Control and Prevention, Atlanta, GA
    • ,
  • William R. Jarvis, MD

      Affiliations

    • Centers for Disease Control and Prevention, Atlanta, GA
    • ,
  • David A. Talan, MD

      Affiliations

    • Department of Medicine, Division of Emergency Medicine, Olive View–University of California–Los Angeles Medical Center, Sylmar, CA
    • ,
  • EMERGEncy ID NET Study Group

      Affiliations

    • All members are listed in the Appendix.

Received 17 December 2007; received in revised form 19 June 2008; accepted 17 July 2008. published online 01 September 2008.

Study objective

Many patients with pneumonia are admitted to respiratory isolation for possible tuberculosis (TB), but most do not have active TB. We created a decision instrument to predict which pneumonia patients do not need admission to a TB isolation bed.

Methods

The design was a prospective case series conducted in 11 university-affiliated, urban, US emergency departments (EDs) (EMERGEncy ID NET). Participants were patients admitted to the hospital through the ED with a diagnosis of pneumonia or suspected TB. The main outcome measure was derivation and validation of a sensitive decision instrument to identify patients not having TB (and not requiring isolation) according to clinical data and chest radiographs.

Results

Of 5,079 pneumonia patients, 224 (4.4%) had pulmonary TB according to sputum cultures or tissue staining. The instrument derived to predict which patients did not have pulmonary TB included no TB history or previous positive tuberculin skin test result, nonimmigrant, not homeless, not recently incarcerated, no recent weight loss, and no apical infiltrate or cavitary lesion on plain chest radiograph. When tested on the validation subgroup, the decision instrument exhibited a negative predictive value of 99.7% (95% confidence interval [CI] 99.1% to 99.9%), and a sensitivity of 96.4% (95% CI 91.1% to 99.0%).

Conclusion

A decision instrument can accurately predict which patients with pneumonia do not require admission to TB isolation rooms.

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 Provide feedback on this article at the journal's Web site, www.annemergmed.com.

 Supervising editors: Kathy J. Rinnert, MD, MPH; Richard C. Dart, MD, PhD

 Author contributions: GJM, WRM, RWP, MJK, WRJ, and DAT conceived and designed the study. GJM, WRM, FMA, SO, JYN, DAT, and the EMERGEncy ID Net Study Group supervised the conduct of the trial and data collection. TWB, WRM, AK, and JYN provided statistical advice and analyzed the data. GJM and TWB drafted the article, and all authors contributed substantially to its revision. GJM takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This study was supported by the Centers for Disease Control and Prevention, Emerging Infections Sentinel Network Program, Cooperative Agreement No. U50/CCU912342-01.

 Publication date: Available online August 29, 2008.

 Reprints not available from the authors.

PII: S0196-0644(08)01514-X

doi:10.1016/j.annemergmed.2008.07.027

Annals of Emergency Medicine
Volume 53, Issue 5 , Pages 625-632, May 2009

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