| ObgectiveChina was one of the countries with a high burden of tuberculosis.Screening,diagnosis and preventive treatment of latent tuberculosis infection was an important part of tuberculosis prevention and control.Latent tuberculosis infection without any symptoms,screening and diagnosis implementation does not reach the designated position,easy to appear in diagnosis when patients accept hormone,this part of the immune inhibitors or the clinical treatment such as biological agents,could increase the chances of latent tuberculosis infection into active tuberculosis,due to the increased risk of tuberculosis transmission in medical institutions.This study was to use clinical decision support system(CDSS)to supervise and control the latent tuberculosis infection in hospitalized patients,before and after comparison and analysis of CDSS application effect of screening and diagnosis of tuberculosis patients at high risk of latent tuberculosis infection,further to explore the clinical application of CDSS in Tuberculosis preventive treatment,and provide reference for the formulation of more accurate and effective latent tuberculosis infection management strategies.MethodsClinical data of inpatients who received tuberculin skin test or interferon-gamma release test in a general hospital from January 1,2019 to December 31,2021 were collected,including age,sex,length of stay,admission diagnosis,past history,test results,medication history,etc.Chi-square test,Mann-Whitney U test and Logistic regression were used to analyze the status and influencing factors of latent tuberculosis infectionIn order to analyze the impact of CDSS application on the screening and diagnosis of latent tuberculosis infection,patients at high risk of latent tuberculosis infection were selected as the study subjects.The patients were divided into groups before and after CDSS application,from January 1,2019 to November 30,2020 as the pre-CDSS application group.The period from December 1,2020 to December 31,2021 was the post-application group of CDSS.The statistical methods were Chi-square test,MannWhitney U test and propensity score matching.In the study period sample,patients receiving preventive treatment for latent tuberculosis infection were the subjects of the study,and trend Chi-square test was used to analyze the trend of the rate of preventive treatment for latent tuberculosis infection.Results1.Status and influencing factors of latent tuberculosis infection(1)11060 inpatients received TST or IGRA detection,more than 70%of which were distributed in the department of respiratory and critical care medicine,department of rheumatology,department of traditional chinese rheumatism,department of lung transplantation,department of nephrology,and department of traditional chinese pulmonary disease.(2)1048 patients were diagnosed as latent tuberculosis infection,and the detection rate was 9.48%.Among them,IGRA detection accounted for 99.14%(1039/1048),and 81.77%(857/1048)combined with chest imaging excluded active tuberculosis.The top five departments in the detection rate of latent tuberculosis infection were rheumatism department of Traditional Chinese medicine,endocrinology department,nephrology department,integrated Traditional Chinese and Western medicine cardiology department and neurology department.(3)Age,length of hospital stay,tuberculosis exposure history,anti-TNF treatment,diabetes mellitus and hypertension were the influencing factors of latent tuberculosis infection.2.Application of CDSS in screening and diagnosis of high risk patients with latent tuberculosis infectionThe application of CDSS is beneficial to improve the screening rate and detection rate of high-risk patients with latent tuberculosis infection.(1)Before the application of CDSS,there were 1231 high-risk patients with latent tuberculosis infection,467 patients were screened for latent tuberculosis infection,and 52 patients with latent tuberculosis infection were diagnosed;After the application of CDSS,802 high-risk patients with latent tuberculosis infection were screened,481 were screened for latent tuberculosis infection,and 76 cases of latent tuberculosis infection were diagnosed.(2)After matching propensity score,the screening rate of latent tuberculosis infection increased from 44.75%(290/648)before CDSS application to 54.48%(353/648)after CDSS application,and the difference was statistically significant(χ2=12.251,P=0.001).The detection rate of latent tuberculosis infection increased from 12.76%(37/290)before CDSS application to 14.73%(52/353)after CDSS application,but the difference was not statistically significant(χ2=0.519,P=0.471).3 Functional requirements of tuberculosis preventive treatment module based on CDSSThe preventive treatment rate of tuberculosis in hospitalized patients was 22.42%(235/1048),and that of tuberculosis in high-risk patients was 18.75%(24/128).Based on the current situation of comprehensive preventive treatment and literature research,the key points of CDSS design of tuberculosis preventive treatment module should include defining the treatment object,recommending preventive treatment scheme,monitoring drug use and planning regular follow-up.Conclusion(1)Age,length of hospital stay,tuberculosis exposure history,anti-TNF treatment,diabetes,hypertension were the influencing factors of latent tuberculosis infection in hospitalized patients.(2)The application of CDSS is beneficial to improve the screening rate of high-risk patients with latent tuberculosis infection,and the detection rate of latent tuberculosis infection is improved but the difference is not significant.(3)The preventive treatment rate of latent tuberculosis infection was low,and the design of CDSS for tuberculosis preventive treatment module should include clarifying treatment objects,recommending preventive treatment plans,monitoring drug use and planning regular follow-up. |
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