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1364. Pretreatment Chest X-ray Stability Duration and Tuberculosis Disease in San Diego County, 2012–2017

BACKGROUND: Repeated chest X-rays serve as an essential screening tool to identify and describe new or stable (i.e., unchanged) lung abnormalities suggestive of pulmonary tuberculosis (TB) disease. The time for which a patient’s chest X-ray has not demonstrated appreciable change prior to treatment,...

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Autores principales: Barber, Casey, Oren, Eyal, Cheng, Yi-Ning, Slater, Madeline, Graves, Susannah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809367/
http://dx.doi.org/10.1093/ofid/ofz360.1228
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author Barber, Casey
Oren, Eyal
Cheng, Yi-Ning
Slater, Madeline
Graves, Susannah
author_facet Barber, Casey
Oren, Eyal
Cheng, Yi-Ning
Slater, Madeline
Graves, Susannah
author_sort Barber, Casey
collection PubMed
description BACKGROUND: Repeated chest X-rays serve as an essential screening tool to identify and describe new or stable (i.e., unchanged) lung abnormalities suggestive of pulmonary tuberculosis (TB) disease. The time for which a patient’s chest X-ray has not demonstrated appreciable change prior to treatment, or pretreatment chest X-ray stability duration, has been considered clinically useful in distinguishing inactive from active disease at four or 6 months. This relationship, however, has not been previously quantified. METHODS: This study relied on retrospective medical record review to assess the relationship of documented pretreatment chest X-ray stability duration thresholds relative to four and 6 months with a future clinical or culture-confirmed (Class 3) diagnosis of pulmonary TB disease. Multivariable logistic regression quantified this association among 146 patients who were evaluated and started on treatment for pulmonary TB disease in the San Diego County tuberculosis clinic between May 2012 and March 2017. RESULTS: After adjusting for age and Class B1 TB, Pulmonary status, a CXR stability duration of 4 months or more was not significantly associated with a Class 3 pulmonary TB diagnosis (adjusted odds ratio [AOR], 0.830; 95% confidence interval [CI], 0.198–3.48). Results were similar for the 6-month cut-point after adjusting for age and Class B1 Pulmonary status (AOR, 0.970; 95% CI, 0.304–3.10). Compared with less than 4 months, CXR stability durations of four to 6 months (AOR, 0.778; 95% CI, 0.156–3.89) and greater than 6 months (AOR, 0.875; 95% CI, 0.187–4.10) were also not significantly associated with a Class 3 TB diagnosis after adjusting for covariates. CONCLUSION: Repeated chest X-rays remain a valuable tool for clinicians identifying and describing new or unchanged lung abnormalities suggestive of pulmonary TB disease. This study found no statistically significant association between pretreatment chest X-ray stability duration and subsequent TB disease diagnosis, with a wide range of estimates compatible with the data, suggesting the stability duration cut points relative to four and 6 months may not be as informative as previously understood. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-68093672019-10-28 1364. Pretreatment Chest X-ray Stability Duration and Tuberculosis Disease in San Diego County, 2012–2017 Barber, Casey Oren, Eyal Cheng, Yi-Ning Slater, Madeline Graves, Susannah Open Forum Infect Dis Abstracts BACKGROUND: Repeated chest X-rays serve as an essential screening tool to identify and describe new or stable (i.e., unchanged) lung abnormalities suggestive of pulmonary tuberculosis (TB) disease. The time for which a patient’s chest X-ray has not demonstrated appreciable change prior to treatment, or pretreatment chest X-ray stability duration, has been considered clinically useful in distinguishing inactive from active disease at four or 6 months. This relationship, however, has not been previously quantified. METHODS: This study relied on retrospective medical record review to assess the relationship of documented pretreatment chest X-ray stability duration thresholds relative to four and 6 months with a future clinical or culture-confirmed (Class 3) diagnosis of pulmonary TB disease. Multivariable logistic regression quantified this association among 146 patients who were evaluated and started on treatment for pulmonary TB disease in the San Diego County tuberculosis clinic between May 2012 and March 2017. RESULTS: After adjusting for age and Class B1 TB, Pulmonary status, a CXR stability duration of 4 months or more was not significantly associated with a Class 3 pulmonary TB diagnosis (adjusted odds ratio [AOR], 0.830; 95% confidence interval [CI], 0.198–3.48). Results were similar for the 6-month cut-point after adjusting for age and Class B1 Pulmonary status (AOR, 0.970; 95% CI, 0.304–3.10). Compared with less than 4 months, CXR stability durations of four to 6 months (AOR, 0.778; 95% CI, 0.156–3.89) and greater than 6 months (AOR, 0.875; 95% CI, 0.187–4.10) were also not significantly associated with a Class 3 TB diagnosis after adjusting for covariates. CONCLUSION: Repeated chest X-rays remain a valuable tool for clinicians identifying and describing new or unchanged lung abnormalities suggestive of pulmonary TB disease. This study found no statistically significant association between pretreatment chest X-ray stability duration and subsequent TB disease diagnosis, with a wide range of estimates compatible with the data, suggesting the stability duration cut points relative to four and 6 months may not be as informative as previously understood. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6809367/ http://dx.doi.org/10.1093/ofid/ofz360.1228 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Barber, Casey
Oren, Eyal
Cheng, Yi-Ning
Slater, Madeline
Graves, Susannah
1364. Pretreatment Chest X-ray Stability Duration and Tuberculosis Disease in San Diego County, 2012–2017
title 1364. Pretreatment Chest X-ray Stability Duration and Tuberculosis Disease in San Diego County, 2012–2017
title_full 1364. Pretreatment Chest X-ray Stability Duration and Tuberculosis Disease in San Diego County, 2012–2017
title_fullStr 1364. Pretreatment Chest X-ray Stability Duration and Tuberculosis Disease in San Diego County, 2012–2017
title_full_unstemmed 1364. Pretreatment Chest X-ray Stability Duration and Tuberculosis Disease in San Diego County, 2012–2017
title_short 1364. Pretreatment Chest X-ray Stability Duration and Tuberculosis Disease in San Diego County, 2012–2017
title_sort 1364. pretreatment chest x-ray stability duration and tuberculosis disease in san diego county, 2012–2017
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809367/
http://dx.doi.org/10.1093/ofid/ofz360.1228
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