Bulletin of the World Health Organization

Feasibility of using teleradiology to improve tuberculosis screening and case management in a district hospital in Malawi

Rebecca Marie Coulborn, Isabella Panunzi, Saskia Spijker, William E Brant, Laura Triviño Duran, Cara S Kosack & Michael Mitchell Murowa

Volume 90, Number 9, September 2012, 705-711

Table 1. Characteristics of patients studied and teleradiology images, Thyolo District Hospital, Malawi, 2010–2011

Variable of interest No. % 95% CI
Age (years)
< 15 22 13.9
15–24 15 9.5
25–34 40 25.3
35–44 30 19.0
45–54 31 19.6
55+ 20 12.7
Total 158 100.0
Sex
Male 77 48.7
Female 80 50.6
Unknown 1 0.6
Total 158 100.0
HIV status
HIV-infected 112 70.9
HIV-negative 39 24.7
Unknown 7 4.4
Total 158 100.0
Type of X-ray
Chest 152 95.6
Spine 6 3.8
Unknown 1 0.6
Total 159a 100.0
Diagnostic agreementb
Yes 112 70.9 63.1–77.8
No 46 29.1 22.2–36.9
Total 158a,c 100.0
Image quality
Good 133 83.6 77.0–89.0
Poor 26 16.4 11.0–23.0
Total 159a 100.0
Image interpretabilityd
Conclusive 89 58.2 49.9–66.1
Inconclusive 64 41.8 33.9–50.1
Total 153a,e 100.0
Treatment
Consistent with radiologist's readingf 133 85.3 78.7–90.4
Consistent with reading by TDH clinical staffg 23 14.7 9.6–21.3
Total 156a,h 100.0
Patient outcome
Improved with treatment 99 65.1 57.0–72.7
Unchanged with treatment 0 0.0 0.0–2.4
Death 23 15.1 9.8–21.8
Transfer 30 19.7 13.7–27.0
Total 152a,i 100.0

CI, confidence interval; HIV, human immunodeficiency virus; TDH, Thyolo District Hospital.

a One patient presented with two distinct medical conditions on hospital admissions five months apart.

b Whether the radiologist reported at least one diagnosis also proposed by clinical staff.

c Diagnostic agreement not documented for one case.

d Whether the radiographic image alone allowed for a definitive diagnosis.

e Image interpretability not documented for six cases.

f Clinical staff agreed with the radiologist’s diagnosis.

g Clinical staff reached a diagnosis that disagreed with the radiologist’s.

h Three patients lost to follow-up before treatment initiation.

i Outcome of seven patients unknown.