Harvard Medical School
Understanding Missed Diagnoses and Treatment Delays in Pediatric Tuberculosis
Tuberculosis (TB) is difficult to diagnose in children and treatment delays can lead to severe and fatal forms of TB. Because children often cannot cough up sputum for testing and often have TB that is undetectable with usual tests, clinicians must diagnose TB based on signs and symptoms. We will study children who meet the standardized definitions for unconfirmed TB but in whom TB was not diagnosed by a physician. We will look for missed TB diagnoses and uncover the reason for discrepancies. We will also conduct interviews with parents, providers and field healthcare workers to better understand the factors that impede or facilitate rapid TB treatment initiation following a TB diagnosis.
Update: To date, we have conducted 17 of 30 qualitative interviews with caregivers, providers and field healthcare workers and initiated transcription of these interviews. We finalized quantitative clinical forms and pulmonologist interview guides, identified a list of eligible children, and finalized the study database. We initiated recruitment for the first part of the study which will follow children who meet the standardized consensus clinical case definitions for unconfirmed TB but in whom TB was not diagnosed by a physician, and look for missed TB diagnoses to better understand the reason for discrepancies in July 2017.