Tuberculosis case finding in hospital admissions.

The value of the x-ray film survey in tuberculosis case finding has been corroborated by many studies during the past 30 years. In numerous surveys emphasis has been placed on age, sex, race, occupation, economic status etc.; other studies have shown that there is a high yield of unsuspected active pulmonary tuberculosis in admissions to general hospitals. It is the purpose of this paper to direct attention to adult admissions to general hospitals as a special population group in which the incidence of unsuspected active pulmonary tuberculosis is still relatively high and to suggest control measures. Bryant’ summarized findings in six surveys of hospital admissions which were published from 1935 to 1945. In only two of these studies were the x-ray film findings verified by clinical and laboratory evidence. Childress et al2 found the prevalence of unsuspected active pulmonary tuberculosis was six per 1000 among 7,187 admissions to Grasslands Hospital from July 1, 1941 to January 1, 1943. Epstein and Meliss5 similarly found that the incidence of unsuspected active pulmonary tuberculosis was six per 1000 among 3,487 hospital admissions to the Flushing Hospital from August 1944 to July 1945. In the remaining four surveys, the findings were based on the x-ray film interpretation of the initial screening film. These reports need verification by follow-up examinations, laboratory and clinical study. The purpose of the x-ray film phase of the survey is to discover unsuspected, previously unknown cases of pulmonary tuberculosis. But the x-ray film by itself although important has its limitations in case-finding and in epidemiological studies. Garland and Cochrane4 have shown that opinions of radiologists and chest specialists vary considerably in their interpretation irrespective of the size of the film. There is disagreement with each other and with themselves to a significant degree on rereading of such films. Errors in interpretation based on films called “positive” was 30 per cent in certain studies. In the present study, results of clinical follow-up examinations of 265 persons suspected of tuberculosis revealed that 84 (32 per cent) were negative. In the New York State Department of Health, Hospital Program,8 results of clinical follow-up examinations of 4,983 persons suspected of tuberculosis revealed that 1,557 (31 per cent) were negative. It is obviously essential that the chest x-ray film survey be combined with an effective verification and clinical follow-up program. Every tuberculosis suspect picked up on the original x-ray film survey must be thoroughly studied to determine the presence of tuberculous infection and the state of activity. Our study has demonstrated the effectiveness of this method in adult admissions to general hospitals.