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Validation of a clinical-radiographic score to assess the probability of pulmonary tuberculosis in suspect patients with negative sputum smears

(2011) PLOS ONE. 6(4).
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Abstract
Background: Clinical 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 Findings: We 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/Significance: In 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.
Keywords
DIAGNOSIS, HIV-INFECTION, ADULTS, ALGORITHM, VALIDITY, PREVALENCE, CLASSIFICATION

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Please use this url to cite or link to this publication:

Chicago
Soto, Alonso, Lely Solari, Javier Díaz, Alberto Mantilla, Francine Matthys, and Patrick Van Der Stuyft. 2011. “Validation of a Clinical-radiographic Score to Assess the Probability of Pulmonary Tuberculosis in Suspect Patients with Negative Sputum Smears.” Plos One 6 (4).
APA
Soto, A., Solari, L., Díaz, J., Mantilla, A., Matthys, F., & Van Der Stuyft, P. (2011). Validation of a clinical-radiographic score to assess the probability of pulmonary tuberculosis in suspect patients with negative sputum smears. PLOS ONE, 6(4).
Vancouver
1.
Soto A, Solari L, Díaz J, Mantilla A, Matthys F, Van Der Stuyft P. Validation of a clinical-radiographic score to assess the probability of pulmonary tuberculosis in suspect patients with negative sputum smears. PLOS ONE. 2011;6(4).
MLA
Soto, Alonso et al. “Validation of a Clinical-radiographic Score to Assess the Probability of Pulmonary Tuberculosis in Suspect Patients with Negative Sputum Smears.” PLOS ONE 6.4 (2011): n. pag. Print.
@article{2023631,
  abstract     = {Background: Clinical 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 Findings: We 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/Significance: In 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.},
  articleno    = {e18486},
  author       = {Soto, Alonso and Solari, Lely and Díaz, Javier and Mantilla, Alberto and Matthys, Francine and Van Der Stuyft, Patrick},
  issn         = {1932-6203},
  journal      = {PLOS ONE},
  keywords     = {DIAGNOSIS,HIV-INFECTION,ADULTS,ALGORITHM,VALIDITY,PREVALENCE,CLASSIFICATION},
  language     = {eng},
  number       = {4},
  pages        = {6},
  title        = {Validation of a clinical-radiographic score to assess the probability of pulmonary tuberculosis in suspect patients with negative sputum smears},
  url          = {http://dx.doi.org/10.1371/journal.pone.0018486},
  volume       = {6},
  year         = {2011},
}

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