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J Korean Soc Emerg Med > Volume 27(6); 2016 > Article
Journal of The Korean Society of Emergency Medicine 2016;27(6): 564-571.
응급실로 내원한 노숙인의 조기 결핵 선별을 위한 임상적 예측인자 연구
백기봉, 신종환, 이휘재, 홍기정, 정진희, 이세종, 정의기
서울대학교 의과대학 보라매병원 응급의학과
Clinical Insights for Early Screening of Pulmonary Tuberculosis in Homeless Patients Who Visited Emergency Department
Ki Bong Baek, Jonghwan Shin, Hui Jai Lee, Kijeong Hong, Jin Hee Jeong, Se Jong Lee, Euigi Jung
Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
Correspondence  Jonghwan Shin ,Tel: 02-870-2662, Fax: 02-870-2826, Email: skyshiner@naver.com,
Received: July 15, 2016; Revised: July 19, 2016   Accepted: September 26, 2016.  Published online: December 31, 2016.
In 2014, Korea ranked as the first among the Organization for Economic Cooperation and Development countries on the prevalence, incidence, and mortality of pulmonary tuberculosis (TB). The prevalence of TB among the homeless was 6.4% in the United State and 7.1% in South Korea. The aim of this study is to develop predicting indicators of TB by analyzing homeless people who visit the public hospital emergency department (ED).
We analyzed 7,500 homeless individuals who visited a public hospital ED between January 1, 2001 and May 31, 2014. A total of 4,552 patients were included, and of these, 145 homeless patients were infected with TB. We conducted univariate and multivariate analysis of clinical variables obtained from the initial check list and later lab analysis, and made a scoring system by weighing each variable. Then applying this scoring system, the area under the receiver (AUC) operating characteristic curve (ROC) was calculated.
The prevalence of TB was 3.2%. The initial meaningful predictor variables were as follows: Being homeless, abnormal heart rate, abnormal respiratory rate, no alcohol intake, hypoalbuminemia, and CRP elevation. The AUC of ROC curve from these predictor variables were 0.815.
We developed a novel scoring system to screen TB patients in a vulnerable social group who visit the ED. We can detect potential TB patients early and effectively control TB, preventing the spread of TB. Prospective internal and external validation is necessary by using the scoring system of TB among the homeless.
Key words: Emergency department, Homeless, Pulmonary tuberculosis
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