Patient Pathway Analysis of Tuberculosis Diagnostic Delay: A Multicentre Retrospective Cohort Study in China
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OBJECTIVES: Delay in diagnosis of tuberculosis (TB) is an important but under-appreciated problem. Our study aimed to analyse the patient pathway and possible risk factors of long diagnostic delay (LDD). METHODS: We enrolled 400 new bacteriologically diagnosed patients with pulmonary TB from 20 hospitals across China. LDD was defined as an interval between the initial care visit and the confirmation of diagnosis exceeding 14 days. Its potential risk factors were investigated by multivariate logistic regression and multilevel logistic regression. Hospitals in China were classified by increasing size, from level 0 to level 3. TB laboratory equipment in hospitals was also evaluated. RESULTS: The median diagnostic delay was 20 days (IQR: 7-72 days), and 229 of 400 patients (57.3%, 95%CI 52.4-62.1) had LDD; 15% of participants were diagnosed at the initial care visit. Compared to level 0 facilities, choosing level 2 (OR 0.27, 95%CI 0.12-0.62, p 0.002) and level 3 facilities (OR 0.34, 95%CI 0.14-0.84, p 0.019) for the initial care visit was independently associated with shorter LDD. Equipping with smear, culture, and Xpert at initial care visit simultaneously also helped to avoid LDD (OR 0.28, 95%CI 0.09-0.82, p 0.020). The multilevel logistic regression yielded similar results. Availability of smear, culture, and Xpert was lower in level 0-1 facilities than in level 2-3 facilities (p < 0.001, respectively). CONCLUSIONS: Most patients failed to be diagnosed at the initial care visit. Patients who went to low-level facilities initially had a higher risk of LDD. Improvement of TB laboratory equipment, especially at low-level facilities, is urgently needed.
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More advanced diagnostic equipment is typically found in higher-tier facilities, and the referral process prolongs the time before patients receive diagnosis and care.
“More advanced diagnostic equipment is typically found in higher-tier facilities, and the referral process prolongs the time before patients receive diagnosis and care [191].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [191]
The equipment-availability section reports significantly less TB diagnostic equipment at lower-tier facilities. The section on initial-visit facility level reports more visits and longer diagnostic delays for patients who first attended those facilities (33 versus 13 days). However, the paper describes patients seeking care at other facilities, not a formal referral process, and does not establish that referrals prolonged time to treatment. (LLM, conf=0.85)
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Research works printed but not linked: 18
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- Authors
- Zhang, L., Weng, T.-P., Wang, H.-Y., Sun, F., Liu, Y.-Y., Lin, K., Zhou, Z., Chen, Y.-Y., Li, Y.-G., Chen, J.-W., Han, L.-J., Liu, H.-M., Huang, F.-L., Cai, C., Yu, H.-Y., Tang, W., Huang, Z.-H., Wang, L.-Z., Bao, L., Ren, P.-F., Deng, G.-F., Lv, J.-N., Pu, Y.-L., Xia, F., Li, T., Deng, Q., He, G.-Q., Li, Y., & Zhang, W.-H.
- Affiliations
- Fudan University (CN)
- Shandong University (CN)
- Anhui Provincial Hospital (CN)
- Second Military Medical University (CN)
- Jiangxi Chest Hospital (CN)
- Harbin Medical University (CN)
- Corresponding author
- Li, Yang
- Venue
- Clinical Microbiology and Infection
- Publisher
- Elsevier BV
- Published
- 2021-07
- Volume
- 27
- Issue
- 7
- Pages
- 1000-1006
- ISSN
- 1198-743X (ISSN-L)
- OpenAlex
- W3120391146
- Cited by
- 36
- References
- 16
- Citations by year
- 2026: 11 · 2025: 13 · 2024: 8 · 2023: 2 · 2022: 1 · 2021: 1
- FWCI
- 0.95
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Microbiology and Infection (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Shanghai Shenkang Hospital Development Center
- National Major Science and Technology Projects of China
- Topics
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Keywords
- tuberculosis, delayed diagnosis, care pathways, risk factors, smear microscopy, culture, Xpert MTB/RIF, pulmonary tuberculosis, China
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Bacteriological Techniques, China, Female, Hospitals, Humans, Male, Middle Aged, Mycobacterium tuberculosis, Retrospective Studies, Risk Factors, Tuberculosis, Young Adult, Delayed Diagnosis
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