{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T21:53:09Z","timestamp":1771710789068,"version":"3.50.1"},"reference-count":40,"publisher":"FapUNIFESP (SciELO)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. bras. pneumol."],"abstract":"<jats:p>ABSTRACT  Objective: Early tuberculosis diagnosis and treatment are determinants of better outcomes and effective disease control. Although tuberculosis should ideally be managed in a primary care setting, a proportion of patients are diagnosed in emergency facilities (EFs). We sought to describe patient characteristics by place of tuberculosis diagnosis and determine whether the place of diagnosis is associated with treatment outcomes. A secondary objective was to determine whether municipal indicators are associated with the probability of tuberculosis diagnosis in EFs.  Methods: We analyzed data from the S\u00e3o Paulo State Tuberculosis Control Program database for the period between January of 2010 and December of 2013. Newly diagnosed patients over 15 years of age with pulmonary, extrapulmonary, or disseminated tuberculosis were included in the study. Multiple logistic regression models adjusted for potential confounders were used in order to evaluate the association between place of diagnosis and treatment outcomes.  Results: Of a total of 50,295 patients, 12,696 (25%) were found to have been diagnosed in EFs. In comparison with the patients who had been diagnosed in an outpatient setting, those who had been diagnosed in EFs were younger and more socially vulnerable. Patients diagnosed in EFs were more likely to have unsuccessful treatment outcomes (adjusted OR: 1.54; 95% CI: 1.42-1.66), including loss to follow-up and death. At the municipal level, the probability of tuberculosis diagnosis in EFs was associated with low primary care coverage, inequality, and social vulnerability. In some municipalities, more than 50% of the tuberculosis cases were diagnosed in EFs.  Conclusions: In the state of S\u00e3o Paulo, one in every four tuberculosis patients is diagnosed in EFs, a diagnosis of tuberculosis in EFs being associated with poor treatment outcomes. At the municipal level, an EF diagnosis of tuberculosis is associated with structural and socioeconomic indicators, indicating areas for improvement.<\/jats:p>","DOI":"10.1590\/s1806-37562017000000384","type":"journal-article","created":{"date-parts":[[2018,5,19]],"date-time":"2018-05-19T16:45:28Z","timestamp":1526748328000},"page":"125-133","source":"Crossref","is-referenced-by-count":7,"title":["Who are the patients with tuberculosis who are diagnosed in emergency facilities? An analysis of treatment outcomes in the state of S\u00e3o Paulo, Brazil"],"prefix":"10.1590","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4677-6862","authenticated-orcid":false,"given":"Otavio Tavares","family":"Ranzani","sequence":"first","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil; London School of Hygiene & Tropical Medicine,  United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9008-660X","authenticated-orcid":false,"given":"Laura Cunha","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"London School of Hygiene & Tropical Medicine,  United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7807-6898","authenticated-orcid":false,"given":"Eliseu Alves","family":"Waldman","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6937-8613","authenticated-orcid":false,"given":"Elena","family":"Prina","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1618-8509","authenticated-orcid":false,"given":"Carlos Roberto Ribeiro","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"530","published-online":{"date-parts":[[2018,4]]},"reference":[{"issue":"3","key":"ref1","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1093\/trstmh\/trv108","article-title":"The WHO's new End TB Strategy in the post-2015 era of the Sustainable Development Goals","volume":"110","author":"L\u00f6nnroth K","year":"2016","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"ref2","series-title":"Global tuberculosis report 2015","year":"2015"},{"issue":"2","key":"ref3","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1590\/0102-311X00195413","article-title":"Health care seeking behavior and patient delay in tuberculosis diagnosis","volume":"31","author":"Almeida CP","year":"2015","journal-title":"Cad Saude Publica"},{"issue":"4","key":"ref4","doi-asserted-by":"crossref","first-page":"ofv171","DOI":"10.1093\/ofid\/ofv171","article-title":"Missed Opportunities to Diagnose Tuberculosis Are Common Among Hospitalized Patients and Patients Seen in Emergency Departments","volume":"2","author":"Miller AC","year":"2015","journal-title":"Open Forum Infect Dis"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1186\/1471-2334-9-91","article-title":"Time delays in diagnosis of pulmonary tuberculosis a systematic review of literature","volume":"9","author":"Sreeramareddy CT","year":"2009","journal-title":"BMC Infect Dis"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/1471-2458-8-15","article-title":"A systematic review of delay in the diagnosis and treatment of tuberculosis","volume":"8","author":"Storla DG","year":"2008","journal-title":"BMC Public Health"},{"issue":"3","key":"ref7","doi-asserted-by":"crossref","first-page":"255","DOI":"10.5588\/ijtld.13.0585","article-title":"Delays in diagnosis and treatment of pulmonary tuberculosis in India a systematic review","volume":"18","author":"Sreeramareddy CT","year":"2014","journal-title":"Int J Tuberc Lung Dis"},{"key":"ref8","series-title":"Manual de recomenda\u00e7\u00f5es para o controle da tuberculose no Brasil","year":"2011"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s12916-016-0584-8","article-title":"The impact of being homeless on the unsuccessful outcome of treatment of pulmonary TB in Sao Paulo State, Brazil","volume":"14","author":"Ranzani OT","year":"2016","journal-title":"BMC Med"},{"key":"ref10","series-title":"Boletim Epidemiol\u00f3gico da Secretaria de Vigil\u00e2ncia em Sa\u00fade","year":"2013"},{"issue":"5","key":"ref11","first-page":"805","article-title":"Profile of tuberculosis patients progressing to death, city of S\u00e3o Paulo, Brazil, 2002","volume":"42","author":"Lindoso AA","year":"2008","journal-title":"Rev Saude Publica"},{"key":"ref12","series-title":"CVE - Centro de Vigil\u00e2ncia Epidemiol\u00f3gica \"Prof. Alexandre Vranjac\". 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