Ghent University Academic Bibliography

Advanced

Evaluation of clinical prediction rules for respiratory isolation of inpatients with suspected pulmonary tuberculosis

Lely Solari, Carlos Acuna-Villaorduna, Alonso Soto and Patrick Van Der Stuyft UGent (2011) CLINICAL INFECTIOUS DISEASES. 52(5). p.595-603
abstract
Background. In the framework of hospital infection control, various clinical prediction rules (CPRs) for respiratory isolation of patients with suspected pulmonary tuberculosis (PTB) have been developed. Our aim was to evaluate their performance in an emergency department setting with a high prevalence of PTB. Methods. We searched the MEDLINE and OVID databases to identify CPRs to predict PTB. We used a previously collected database containing clinical, radiographical, and microbiological information on patients attending an emergency department with respiratory complaints, and we applied each CPR to every patient and compared the result with culture for Mycobacterium tuberculosis as the reference standard. We also simulated the proportion of isolated suspects and missed cases for PTB prevalences of 5% and 30%. Results. We withheld 13 CPRs for evaluation. We had complete data on 345 patients. Most CPRs achieved a high sensitivity but very low specificity and very low positive predictive value. Mylotte's score, which includes results of sputum smear as a predictive finding, was the best-performing CPR. It attained a sensitivity of 88.9% and a specificity of 63.9%. However, at a 30% PTB prevalence, 498 of 1000 individuals with suspected PTB would have to be isolated; 267 of these cases would be true PTB cases, and 33 cases would be missed. Two consecutive sputum smears had a sensitivity of 75.6% and a specificity of 99.7%. Conclusions. In a setting with a high prevalence of PTB, only 1 of the 13 assessed CPRs demonstrated high sensitivity combined with satisfactory specificity. Our results highlight the need for local validation of CPRs before their application.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
ACID-FAST BACILLI, MYCOBACTERIUM-TUBERCULOSIS, HEALTH-CARE WORKERS, METHODOLOGICAL STANDARDS, EMERGENCY-DEPARTMENTS, DECISION INSTRUMENT, MEDICAL LITERATURE, USERS GUIDES, MODEL, VALIDATION
journal title
CLINICAL INFECTIOUS DISEASES
Clin. Infect. Dis.
volume
52
issue
5
pages
595 - 603
Web of Science type
Article
Web of Science id
000286991700012
JCR category
INFECTIOUS DISEASES
JCR impact factor
9.154 (2011)
JCR rank
2/70 (2011)
JCR quartile
1 (2011)
ISSN
1058-4838
DOI
10.1093/cid/ciq186
language
English
UGent publication?
no
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
2023777
handle
http://hdl.handle.net/1854/LU-2023777
date created
2012-02-08 13:00:51
date last changed
2016-12-19 15:42:02
@article{2023777,
  abstract     = {Background. In the framework of hospital infection control, various clinical prediction rules (CPRs) for respiratory isolation of patients with suspected pulmonary tuberculosis (PTB) have been developed. Our aim was to evaluate their performance in an emergency department setting with a high prevalence of PTB. 
Methods. We searched the MEDLINE and OVID databases to identify CPRs to predict PTB. We used a previously collected database containing clinical, radiographical, and microbiological information on patients attending an emergency department with respiratory complaints, and we applied each CPR to every patient and compared the result with culture for Mycobacterium tuberculosis as the reference standard. We also simulated the proportion of isolated suspects and missed cases for PTB prevalences of 5\% and 30\%. 
Results. We withheld 13 CPRs for evaluation. We had complete data on 345 patients. Most CPRs achieved a high sensitivity but very low specificity and very low positive predictive value. Mylotte's score, which includes results of sputum smear as a predictive finding, was the best-performing CPR. It attained a sensitivity of 88.9\% and a specificity of 63.9\%. However, at a 30\% PTB prevalence, 498 of 1000 individuals with suspected PTB would have to be isolated; 267 of these cases would be true PTB cases, and 33 cases would be missed. Two consecutive sputum smears had a sensitivity of 75.6\% and a specificity of 99.7\%. 
Conclusions. In a setting with a high prevalence of PTB, only 1 of the 13 assessed CPRs demonstrated high sensitivity combined with satisfactory specificity. Our results highlight the need for local validation of CPRs before their application.},
  author       = {Solari, Lely and Acuna-Villaorduna, Carlos and Soto, Alonso and Van Der Stuyft, Patrick},
  issn         = {1058-4838},
  journal      = {CLINICAL INFECTIOUS DISEASES},
  keyword      = {ACID-FAST BACILLI,MYCOBACTERIUM-TUBERCULOSIS,HEALTH-CARE WORKERS,METHODOLOGICAL STANDARDS,EMERGENCY-DEPARTMENTS,DECISION INSTRUMENT,MEDICAL LITERATURE,USERS GUIDES,MODEL,VALIDATION},
  language     = {eng},
  number       = {5},
  pages        = {595--603},
  title        = {Evaluation of clinical prediction rules for respiratory isolation of inpatients with suspected pulmonary tuberculosis},
  url          = {http://dx.doi.org/10.1093/cid/ciq186},
  volume       = {52},
  year         = {2011},
}

Chicago
Solari, Lely, Carlos Acuna-Villaorduna, Alonso Soto, and Patrick Van Der Stuyft. 2011. “Evaluation of Clinical Prediction Rules for Respiratory Isolation of Inpatients with Suspected Pulmonary Tuberculosis.” Clinical Infectious Diseases 52 (5): 595–603.
APA
Solari, L., Acuna-Villaorduna, C., Soto, A., & Van Der Stuyft, P. (2011). Evaluation of clinical prediction rules for respiratory isolation of inpatients with suspected pulmonary tuberculosis. CLINICAL INFECTIOUS DISEASES, 52(5), 595–603.
Vancouver
1.
Solari L, Acuna-Villaorduna C, Soto A, Van Der Stuyft P. Evaluation of clinical prediction rules for respiratory isolation of inpatients with suspected pulmonary tuberculosis. CLINICAL INFECTIOUS DISEASES. 2011;52(5):595–603.
MLA
Solari, Lely, Carlos Acuna-Villaorduna, Alonso Soto, et al. “Evaluation of Clinical Prediction Rules for Respiratory Isolation of Inpatients with Suspected Pulmonary Tuberculosis.” CLINICAL INFECTIOUS DISEASES 52.5 (2011): 595–603. Print.