An online method for diagnosis of difficult TB cases for developing countries.
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Date
2011-02-21
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Abstract
Optimal use of limited human technical and financial resources is a major concern for tuberculosis TB control in developing nations Further impediments include a lack of trained physicians and logistical difficulties in arranging face to face f 2 f TB Diagnostic Committee TBDC consultations Use of e Health for virtual TBDCs Internet and iPath to address such issues is being studied in the Philippines and Pakistan In Pakistan radiological diagnosis of 88 sputum smear negative but suspected TB patients has been compared with the gold standards TB culture and 2 month clinical follow up Of 88 diagnostic decisions made by primary physicians at the spoke site and electronic TBDC e TBDC at hub site there was agreement in 71 cases and disagreement on 17 cases The turn around time TAT patient registration at spoke site for f 2 f diagnosis to receiving the electronic diagnosis averaged 34 6 hours ranging 9 minutes to 289 2 hours Average TAT at the rural site 59 15 hours was more than the urban site 15 9 hours Comparison of e TBDC and f 2 f diagnosis with the gold standards showed only slight differences Using culture as the gold standard e TBDC decisions showed greater accuracy sensitivity 32 4 as compared to f 2 f 27 6 using 2 month clinical follow up as the gold standard f 2 f diagnosis showed slightly better improvement in patient symptoms and weight as compared to e TBDC In Philippines iPath was trialed and demonstrated that e TBDCs have potential Such groups could review cases diagnose and write comments remotely reducing the diagnosis and treatment delay compared to usual care