{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,7,25]],"date-time":"2024-07-25T05:13:03Z","timestamp":1721884383377},"reference-count":23,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2011,7,15]],"date-time":"2011-07-15T00:00:00Z","timestamp":1310688000000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2011,7]]},"abstract":"<jats:sec><jats:label \/><jats:p>ACADEMIC EMERGENCY MEDICINE 2011; 18:726\u2013732 \u00a9 2011 by the Society for Academic Emergency Medicine<\/jats:p><\/jats:sec><jats:sec><jats:title>Abstract<\/jats:title><jats:p><jats:bold>Objectives:\u2002<\/jats:bold> The objectives were to describe emergency department (ED) presentations of children with tuberculosis (TB) disease and assess the utility in children of TB screening tools developed for adults.<\/jats:p><jats:p><jats:bold>Methods:\u2002<\/jats:bold> Children at most 18\u2003years old with confirmed or probable TB seen at the Children\u2019s TB Clinic from 2005 to 2009 who were initially evaluated in the ED for symptoms compatible with TB in the preceding month were included. TB was classified as microbiologically confirmed disease or probable TB disease, as defined by the World Health Organization.<\/jats:p><jats:p><jats:bold>Results:\u2002<\/jats:bold> Sixty children (29 with confirmed TB and 31 with probable TB) were identified after presentation to the ED, representing 35% of all children diagnosed with TB at the two hospitals during this interval. Eighty\u2010eight percent were previously healthy. Fifty\u2010five percent were Hispanic, 30% were black or African American, 12% were Asian, and 3% were white. Forty\u2010four (73%) had intrathoracic disease (37 pulmonary parenchymal or pleural disease, four miliary disease, two endobronchial, one pericarditis). Sixteen (27%) had extrathoracic disease (eight meningitis, five cervical lymphadenopathy, two gastrointestinal, one interstitial keratitis), 11 of whom also had abnormal chest radiographs, including all eight children with TB meningitis. Most (76.7%) were diagnosed at the time of their first ED visit or during their first hospital admission, 12% after their second ED visit, 10% after their third ED visit, and one patient after six ED visits to various facilities. In 33 case (55%), the diagnosis was suspected in the ED because of epidemiologic risk factors (15), radiographic evaluation (11), or symptoms (7). Hemoptysis (12%) and night sweats (10%) were uncommon. Neither cavitary lesions (seen in two children) nor apical lesions (seen in 42%) predominated. The five screening tools validated for adults with pulmonary disease were 77% to 98% sensitive in identifying children with intrathoracic TB and 50% to 100% sensitive for extrathoracic TB.<\/jats:p><jats:p><jats:bold>Conclusions:\u2002<\/jats:bold> The point of entry to health care for many children with TB is the ED. The more protean manifestations of TB in children can decrease the utility of screening tools developed to identify adults with TB. While TB in adults often is a microbiologic diagnosis, childhood TB often is an epidemiologic diagnosis. Therefore, questioning caregivers about TB risk factors in the family may identify a higher percentage of children with possible TB.<\/jats:p><\/jats:sec>","DOI":"10.1111\/j.1553-2712.2011.01112.x","type":"journal-article","created":{"date-parts":[[2011,7,15]],"date-time":"2011-07-15T13:42:10Z","timestamp":1310737330000},"page":"726-732","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Emergency Department Presentation of Children With Tuberculosis"],"prefix":"10.1111","volume":"18","author":[{"given":"Andrea T.","family":"Cruz","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lydia T.","family":"Ong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey R.","family":"Starke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2011,7,15]]},"reference":[{"key":"e_1_2_7_2_2","volume-title":"Reported Tuberculosis in the United States, 2008","author":"Centers for Disease Control and Prevention","year":"2009"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid1506.081617"},{"key":"e_1_2_7_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2009.01.011"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2009.05.002"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(00)70050-3"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.87.9.1543"},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2008.07.027"},{"key":"e_1_2_7_9_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.115.5.1248"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.165.4.453"},{"key":"e_1_2_7_11_2","unstructured":"World Health Organization.Guidance for National Tuberculosis Programmes on the Management of Tuberculosis in Children. Available at:http:\/\/whqlibdoc.who.int\/hq\/2006\/WHO_HTM_TB_2006.371_eng.pdf. Accessed Apr 23 2011."},{"key":"e_1_2_7_12_2","first-page":"332","article-title":"The emergency department is a determinant point of contact of tuberculosis patients prior to diagnosis","volume":"6","author":"Long R","year":"2002","journal-title":"Int J Tuberc Lung Dis."},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2000.tb02100.x"},{"key":"e_1_2_7_14_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.107.4.777"},{"key":"e_1_2_7_15_2","first-page":"992","article-title":"Patient and health care system delays in pulmonary tuberculosis diagnosis in a low\u2010incidence state","volume":"9","author":"Golub JE","year":"2005","journal-title":"Int J Tuberc Lung Dis."},{"key":"e_1_2_7_16_2","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.161.4.16141"},{"key":"e_1_2_7_17_2","first-page":"316","article-title":"Extrapulmonary tuberculosis","volume":"120","author":"Sharma SK","year":"2004","journal-title":"Indian J Med Res."},{"key":"e_1_2_7_18_2","doi-asserted-by":"publisher","DOI":"10.1086\/648593"},{"key":"e_1_2_7_19_2","doi-asserted-by":"publisher","DOI":"10.1086\/649209"},{"key":"e_1_2_7_20_2","first-page":"414","article-title":"Tuberculosis during infancy","volume":"4","author":"Maltezou HC","year":"2000","journal-title":"Int J Tuberc Lung Dis."},{"key":"e_1_2_7_21_2","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.165.7.2107040"},{"key":"e_1_2_7_22_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.107.4.e54"},{"key":"e_1_2_7_23_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.1937.tb16670.x"},{"key":"e_1_2_7_24_2","doi-asserted-by":"publisher","DOI":"10.1086\/501972"}],"container-title":["Academic Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fj.1553-2712.2011.01112.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1553-2712.2011.01112.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,15]],"date-time":"2023-10-15T13:23:31Z","timestamp":1697376211000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1553-2712.2011.01112.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,7]]},"references-count":23,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2011,7]]}},"alternative-id":["10.1111\/j.1553-2712.2011.01112.x"],"URL":"https:\/\/doi.org\/10.1111\/j.1553-2712.2011.01112.x","archive":["Portico"],"relation":{},"ISSN":["1069-6563","1553-2712"],"issn-type":[{"value":"1069-6563","type":"print"},{"value":"1553-2712","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,7]]},"assertion":[{"value":"2011-07-15","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}