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Journal of Clinical Microbiology, September 2004, p. 4209-4213, Vol. 42, No. 9
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.9.4209-4213.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Laboratory Reporting of Tuberculosis Test Results and Patient Treatment Initiation in California

Lisa Pascopella,^1* Steffi Kellam,² John Ridderhof,³ Daniel P. Chin,⁴ Arthur Reingold,² Edward Desmond,⁵ Jennifer Flood,¹ and Sarah Royce¹

California Department of Health Services Tuberculosis Control Branch,¹ School of Public Health, University of California at Berkeley, Berkeley,⁴ California Department of Health Services Microbial Diseases Laboratory, Richmond, California,⁵ Centers for Disease Control and Prevention PHPPO, Atlanta, Georgia,² World Health Organization, Beijing, China³

Received 25 November 2003/ Returned for modification 5 January 2004/ Accepted 1 June 2004

Prompt laboratory reporting of tuberculosis (TB) test results is necessary for TB control. To understand the extent of and factors contributing to laboratory reporting delays and the impact of reporting delays on initiation of treatment of TB patients, we analyzed data from 300 consecutive culture-positive TB cases reported in four California counties in 1998. Laboratory reporting to the specimen submitter was delayed for 26.9% of smear-positive patients and 46.8% of smear-negative patients. Delays were associated with the type of laboratory that performed the testing and with delayed transport of specimens. Referral laboratories (public health and commercial) had longer median reporting time frames than hospital and health maintenance organization laboratories. Among patients whose treatment was not started until specimens were collected, those with delayed laboratory reporting were more likely to have delayed treatment than patients with no laboratory reporting delays (odds ratio [OR] of 3.9 and 95% confidence interval [CI] of 1.6 to 9.7 for smear-positive patients and OR of 13.1 and CI of 5.3 to 32.2 for smear-negative patients). This relation remained after adjustment in a multivariate model for other factors associated with treatment delays (adjusted OR of 25.64 and CI of 7.81 to 83.33 for smear-negative patients). These findings emphasize the need to reduce times of specimen transfer between institutions and to ensure rapid communication among laboratories, health care providers, and health departments serving TB patients.

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* Corresponding author. Mailing address: California Department of Health Services Tuberculosis Control Branch, 2151 Berkeley Way, Rm. 608, Berkeley, CA 94704. Phone: (510) 540-3585. Fax: (510) 540-3535. E-mail: Lpascope{at}dhs.ca.gov.

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Journal of Clinical Microbiology, September 2004, p. 4209-4213, Vol. 42, No. 9
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.9.4209-4213.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

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