ArticleBMJ open2021
Incidence, duration and risk factors associated with delayed and missed diagnostic opportunities related to tuberculosis: a population-based longitudinal study.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it, 22 citations in OpenAlex.
- Diagnostic windows in non-neoplastic diseases: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2023Pooled it
- Article
- The Diagnostic Course of Sarcoidosis: A Population-Based Study Highlighting Risk Factors for a Delay in Diagnosis.Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG · 2026Article
- Rural Residence and One-Person Households Are Associated with Diagnostic Delay in Pulmonary Tuberculosis in a Low-Incidence European Setting.Tropical medicine and infectious disease · 2026Article
- Healthcare system strain and healthcare seeking behavior: the lingering impact of the COVID-19 pandemic on TB delayed diagnosis in Snohomish County, Washington.Journal of clinical tuberculosis and other mycobacterial diseases · 2026Article
- Frequency and Duration of Diagnostic Delays Associated with Coccidioidomycosis and Risk Factors for Missed Diagnoses, United States.Emerging infectious diseases · 2026Article
- Risk Factors Associated With Tuberculosis Diagnostic Delay in the Jiangsu Province, China (2011-2021): Spatiotemporal Database Analysis Study.JMIR public health and surveillance · 2026Article
- Incidence, Duration, and Risk Factors for Diagnostic Delays Associated with Dengue: A Population-Based Study.The American journal of tropical medicine and hygiene · 2025Article
- Evaluating Potential Missed Opportunities to Prevent, Treat, or Diagnose Sepsis: A Population-Based Retrospective Study of Insurance Claims.Critical care explorations · 2025Article
- Challenges Facing Antimicrobial Stewardship Programs in the Endemic Region for Coccidioidomycosis.Open forum infectious diseases · 2024Review
- A taxonomy of early diagnosis research to guide study design and funding prioritisation.British journal of cancer · 2023Review
- The incidence, duration, risk factors, and age-based variation of missed opportunities to diagnose pertussis: A population-based cohort study.Infection control and hospital epidemiology · 2023Article
- Optimizing measurement of misdiagnosis-related harms using symptom-disease pair analysis of diagnostic error (SPADE): comparison groups to maximize SPADE validity.Diagnosis (Berlin, Germany) · 2023Article
- A comprehensive framework to estimate the frequency, duration, and risk factors for diagnostic delays using bootstrapping-based simulation methods.BMC medical informatics and decision making · 2023Article
- Predictive Factors and Clinical Impacts of Delayed Isolation of Tuberculosis during Hospital Admission.Journal of clinical medicine · 2023Article
- A clinically-guided unsupervised clustering approach to recommend symptoms of disease associated with diagnostic opportunities.Diagnosis (Berlin, Germany) · 2023Article
- Article
- A narrative review of tuberculosis in the United States among persons aged 65 years and older.Journal of clinical tuberculosis and other mycobacterial diseases · 2022Review
- Frequency and Duration of, and Risk Factors for, Diagnostic Delays Associated with Histoplasmosis.Journal of fungi (Basel, Switzerland) · 2022Article
- The probability of diagnostic delays for tuberculosis and its associated risk factors in northwest Iran from 2005 to 2016: a survival analysis using tuberculosis surveillance data.Epidemiology and health · 2022Article
Corrections and comments
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
Abstract
objectivesMissed opportunities to diagnose tuberculosis are costly to patients and society. In this study, we (1) estimate the frequency and duration of diagnostic delays among patients with active pulmonary tuberculosis and (2) determine the risk factors for experiencing a diagnostic delay.
designA retrospective cohort study of patients with tuberculosis using longitudinal healthcare encounters prior to diagnosis.
settingCommercially insured enrollees from the Commercial Claims and Encounters or Medicare Supplemental IBM Marketscan Research Databases, 2001-2017.
participantsAll patients diagnosed with, and receiving treatment for, pulmonary tuberculosis, enrolled at least 365 days prior to diagnosis. PRIMARY AND SECONDARY OUTCOME MEASURES: We estimated the number of visits with tuberculosis-related symptoms prior to diagnosis that would be expected to occur in the absence of delays and compared this estimate to the observed pattern. We computed the number of visits representing a delay and used a simulation-based approach to estimate the number of patients experiencing a delay, number of missed opportunities per patient and duration of delays (ie, time between diagnosis and earliest missed opportunity). We also explored risk factors for missed opportunities.
resultsWe identified 3371 patients diagnosed and treated for active tuberculosis that could be followed up for 1 year prior to diagnosis. We estimated 77.2% (95% CI 75.6% to 78.7%) of patients experienced at least one missed opportunity; of these patients, an average of 3.89 (95% CI 3.65 to 4.14) visits represented a missed opportunity, and the mean duration of delay was 31.66 days (95% CI 28.51 to 35.11). Risk factors for delays included outpatient or emergency department settings, weekend visits, patient age, influenza season presentation, history of chronic respiratory symptoms and prior fluoroquinolone use.
conclusionsMany patients with tuberculosis experience multiple missed diagnostic opportunities prior to diagnosis. Missed opportunities occur most commonly in outpatient settings and numerous patient-specific, environment-specific and setting-specific factors increase risk for delays.
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