某专科医院723例学生肺结核住院患者诊疗延误情况分析  

Delay in diagnosis and treatment of 723 students with pulmonary tuberculosis in some specialized hospital

作　　者：陈文翰[1] 周强[1] 刘玉美[1] 郑闽莉[1] 卓文基 余美玲 刘志辉[1] Chen Wenhan;Zhou Qiang;Liu Yumei;Zheng Minli;Zhuo Wenji;Yu Meiling;Liu Zhihui(Guangzhou Chest Hospital,Guangzhou 510095,China;Centre for Tuberculosis Control of Guangdong Province,Guangzhou 510630,China)

机构地区：[1]广州市胸科医院,广州510095 [2]广东省结核病控制中心,广州510630

出　　处：《国际医药卫生导报》2022年第19期2722-2726,共5页International Medicine and Health Guidance News

基　　金：广东省医学科学技术研究基金(C2020043、C20220042);广州市医学重点学科(结核病学)建设项目(2021-2023);2020年广州市卫生健康科技重大专项(2020A031003)。

摘　　要：目的分析学生肺结核患者就诊、诊断延误情况,探讨学生结核病例发现的主要影响因素。方法在医院“统计病案”系统内以“出院时间”“职业”“主要诊断国际疾病分类编码”搜寻2019—2021年因肺结核在广州市胸科医院住院的学生肺结核患者资料,从电子病历中获取症状出现时间、初诊时间和肺结核确诊时间,以前两者间隔为就诊时间、后两者间隔为诊断时间,≥15 d者分别为就诊延误和诊断延误,比较分析性别(男/女)、学生类别(小学生/初中生/高中生/本科生/研究生)、病例发现方式(因症就诊/转诊/因症推荐/健康体检)和症状始发月份(1—2月/3—6月/7—8月/9—12月)各人群中的两种延误情况。采用χ^(2)检验、Mann-Whitney U检验和Kruskal-Wallis秩和检验。结果3年间学生肺结核住院患者共计723例,就诊时间0~92 d,其中406例(56.16%)存在就诊延误,就诊时间中位数为25 d(15~92 d);诊断时间1~95 d,其中503例(69.57%)存在诊断延误,诊断时间中位数为24 d(15~95 d)。经χ^(2)检验,病例发现方式各组间就诊延误发生率差异有统计学意义(χ^(2)=33.288,P˂0.001),性别、症状始发月份各组间诊断延误率差异均有统计学意义(χ^(2)=10.029,P=0.002;χ^(2)=18.187,P˂0.001)。经Mann-Whitney U检验(两组间比较)和Kruskal-Wallis秩和检验(多组间比较),学生类别、症状始发月份各组间就诊延误时间差异均有统计学意义(χ^(2)=33.000,P˂0.001;χ^(2)=12.750,P=0.005),症状始发月份各组间诊断延误时间差异有统计学意义(χ^(2)=15.987,P=0.001)。结论学生肺结核患者就诊延误和诊断延误发生率高,延误程度与性别、学生类别、病例发现方式和症状始发月份均密切相关。ed from the electronic medical records of the"Hospital Statistical Medical Record System"searching the terms"discharge time","occupation",and"international classification code of main diagnoses of diseases".The intervals between symptom onset time and initial visit time and between the interval between initial visit time and disease diagnosis time were the visit time and the diagnosis time,respectively;the times≥15 days were defined as visit delay and diagnosis delay accordingly.The two kinds of delays of different groups were described,inferred,and analyzed statistically;they were grouped according to gender(male/female),student levels(primary school student/junior high schools tudent/high school student/undergraduate/postgraduate),case finding methods(seeking medical attention in tuberculosis control agency/referral from general hospital/recommendation by medical staff of primary health care institutions/physical examination),and symptom onset month(from January to February/from March to June/from July to August/from September to December).Theχ^(2),Mann-Whitney U,and Kruskal-Wallis rank sum tests were applied.Results There were 723 hospitalized students with pulmonary tuberculosis during the three years;their visit time was 0-92 days,and 406 cases(56.16%)had visit delay of 15-92 days(median 25 days);their diagnosis time was 1-95 days,and 503 cases(69.57%)had diagnosis delay of 15-95 days(median 24 days).There was a statistical difference in the incidence of visit delay between the groups of case finding method(χ^(2)=33.288,P˂0.001);there were statistical differences in the incidence of diagnosis delay between the groups of gender and symptom onset month(χ^(2)=10.029,P=0.002;χ^(2)=18.187,P˂0.001)byχ^(2) test.There were statistical differences in visit delay time betweeb the groups of student level and symptom onset month(χ^(2)=33.000,P˂0.001;χ^(2)=12.750,P=0.005)and was in diagnosis delay time between the groups of symptom onset month(χ^(2)=15.987,P=0.001)by Mann-Whitney U test(comparison between tw

关 键 词：肺结核 学生 就诊延误 诊断延误 

分 类 号：R521[医药卫生—内科学]