某专科医院723例学生肺结核住院患者诊疗延误情况分析

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χ²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χ²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（χ²=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（χ²=10.029，P=0.002；χ²=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（χ²=33.000，P˂0.001；χ²=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（χ²=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。

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

Objective　To explore the main influencing factors of tuberculosis studentsanalyzing visit delay and diagnosis delay of students with pulmonarytuberculosis. Methods　The relevant informationincluding symptom onset times, initial visit times, and disease diagnosis timesof the hospitalized students with pulmonary tuberculosis from 2019 to 2021 wasobtained, which were abstracted from the electronic medical records of the"Hospital Statistical Medical Record System" searching the terms"discharge time", "occupation", and "internationalclassification code of main diagnoses of diseases". The intervals betweensymptom onset time and initial visit time and between the interval between initialvisit time and disease diagnosis time were the visit time and the diagnosistime, respectively; the times ≥ 15 days were definedas visit delay and diagnosis delay accordingly. The two kinds of delays ofdifferent groups were described, inferred, and analyzed statistically; theywere grouped according to gender (male / female), student levels (primaryschool student / junior high schools tudent / high school student /undergraduate / postgraduate), case finding methods (seeking medical attentionin tuberculosis control agency / referral from general hospital /recommendation by medical staff of primary health care institutions / physicalexamination), and symptom onset month (from January to February / from March toJune / from July to August / from September to December). The χ², Mann-Whitney U, and Kruskal-Wallis rank sum tests were applied. Results　There were 723 hospitalized students with pulmonary tuberculosis duringthe three years; their visit time was 0-92 days, and 406 cases (56.16%) hadvisit 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 thegroups of case finding method (χ²=33.288, P˂0.001); there were statistical differences inthe incidence of diagnosis delay between the groups of gender and symptom onsetmonth (χ²=10.029, P=0.002; χ²=18.187, P˂0.001) by χ² test. There were statistical differences in visit delay time betweeb the groupsof student level and symptom onset month (χ²=33.000, P˂0.001; χ²=12.750, P=0.005) and was in diagnosis delaytime between the groups of symptom onset month (χ²=15.987, P=0.001)by Mann- Whitney U test (comparisonbetween two groups) or Kruskal-Wallis rank-sum test (comparison between ≥3 groups). Conclusions　There are high incidences of visit delay and diagnosis delay in studentswith pulmonary tuberculosis. And the degree of delay is closely related togender, student level, case finding methods, and symptom onset month.