Role of Cough Officer Screening in Early Detection of Pulmonary Tuberculosis in Inpatients

Background: In order to avoid the transmission of tuberculosis within the hospital, the early detection and treatment of active cases are fundamental tuberculosis control strategies. The aim of this study was to evaluate a computerized protocol, the so-called cough officer screening, for the early detection of pulmonary tuberculosis in inpatients. Materials and Methods: A computerized cough officer screening protocol was used in Changhua Christian Hospital from Oct 2004 to Sep 2005. All inpatients were enrolled and their cough history recorded. The computerized physician order entry system reminded the doctors to survey those patients who had a cough of more than 5 days in duration. Chest radiography, sputum smears, and cultures were prescribed to determine if patients had active pulmonary tuberculosis. Results: A total of 57,745 inpatients were recruited into this study. The cough officer screening system identified 6,971 (12%) patients with cough duration longer than 5 days. Among them, 2,088 (30%) patients had chest radiography and/or sputum acid-fast smear and culture examinations. Eighteen were diagnosed with active pulmonary tuberculosis, and all were admitted to the medical ward. Based on the TB reporting information system, 151 inpatients were diagnosed with pulmonary tuberculosis during this study period, and the case detection rate using cough officer screening was 12% (18/151). The average cost per case finding was NT$49,865. Conclusions: Cough officer screening is effective in the early detection of active pulmonary tuberculosis in inpatients. Strategies to improve doctors' compliance with this screening system will increase the case finding rate. In terms of cost-effectiveness, the internal medicine department is the most important target for screening. Determining the most appropriate cutoff point for cough duration requires further study.