The role of chest radiography in the suspicion for and diagnosis of pulmonary tuberculosis in intensive care units.

BACKGROUND: The role of chest radiography (CXR) in the clinical diagnosis and suspicion of pulmonary tuberculosis (PTB) remains uncertain in the intensive care unit (ICU) setting. DESIGN: This case-control study compared the radiographic findings between ICU patients with and without co-existing PTB to define any predictive patterns for the diagnosis of PTB. Further analysis aimed to elucidate the impact of CXR on the clinical suspicion of PTB. RESULTS: Eighty-nine (89) patients with PTB and an equal number of matched controls were evaluated. Consolidation was the most frequent radiographic pattern. There were no specific predictors for diagnosing PTB in the ICU. Of 89 patients, 55 (62.9%) had a delay in clinical suspicion of PTB. The time from ICU admission to TB diagnosis was significantly delayed in the group without clinical suspicion (30.7 vs. 5.3 days, P < 0.001). In multivariate analysis, a history of PTB was significantly associated with the clinical suspicion of PTB (OR 7.94, P = 0.012), but CXR patterns were not. CONCLUSION: CXR does not contribute as much as expected in the clinical diagnosis and suspicion of PTB in the ICU setting.