Validation of a clinical-radiographic score to assess the probability of pulmonary tuberculosis in suspect patients with negative sputum smears |
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Authors: | Soto Alonso Solari Lely Díaz Javier Mantilla Alberto Matthys Francine van der Stuyft Patrick |
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Institution: | Department of Medicine, Hospital Nacional Hipólito Unanue, Lima, Peru. sotosolari@yahoo.com |
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Abstract: | BackgroundClinical suspects of pulmonary tuberculosis in which the sputum smears are
negative for acid fast bacilli represent a diagnostic challenge in resource
constrained settings. Our objective was to validate an existing
clinical-radiographic score that assessed the probability of smear-negative
pulmonary tuberculosis (SNPT) in high incidence settings in Peru.Methodology/Principal FindingsWe included in two referral hospitals in Lima patients with clinical
suspicion of pulmonary tuberculosis and two or more negative sputum smears.
Using a published but not externally validated score, patients were
classified as having low, intermediate or high probability of pulmonary
tuberculosis. The reference standard for the diagnosis of tuberculosis was a
positive sputum culture in at least one of 2 liquid (MGIT or Middlebrook
7H9) and 1 solid (Ogawa) media. Prevalence of tuberculosis was calculated in
each of the three probability groups.684 patients were included. 184 (27.8%) had a diagnosis of pulmonary
tuberculosis. The score did not perform well in patients with a previous
history of pulmonary tuberculosis. In patients without, the prevalence of
tuberculosis was 5.1%, 31.7% and 72% in the low,
intermediate and high probability group respectively. The area under de ROC
curve was 0.76 (95% CI 0.72–0.80) and scores ≥6 had a
positive LR of 10.9.Conclusions/SignificanceIn smear negative suspects without previous history of tuberculosis, the
clinical-radiographic score can be used as a tool to assess the probability
of pulmonary tuberculosis and to guide the decision to initiate or defer
treatment or to requesting additional tests. |
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