Validity of clinical prediction rules for isolating inpatients with suspected tuberculosis. A systematic review.

Division of General Internal Medicine, Mount Sinai Medical Center, New York, NY. USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 11/2005; 20(10):947-52. DOI: 10.1111/j.1525-1497.2005.0185.x
Source: PubMed

ABSTRACT Declining rates of tuberculosis (TB) in the United States has resulted in a low prevalence of the disease among patients placed on respiratory isolation. The purpose of this study is to systematically review decision rules to predict the patient's risk for active pulmonary TB at the time of admission to the hospital.
We searched MEDLINE (1975 to 2003) supplemented by reference tracking. We included studies that reported the sensitivity and specificity of clinical variables for predicting pulmonary TB, used Mycobacterium TB culture as the reference standard, and included at least 50 patients.
Two reviewers independently assessed study quality and abstracted data regarding the sensitivity and specificity of the prediction rules.
Nine studies met inclusion criteria. These studies included 2,194 participants. Most studies found that the presence of TB risk factors, chronic symptoms, positive tuberculin skin test (TST), fever, and upper lobe abnormalities on chest radiograph were associated with TB. Positive TST and a chest radiograph consistent with TB were the predictors showing the strongest association with TB (odds ratio: 5.7 to 13.2 and 2.9 to 31.7, respectively). The sensitivity of the prediction rules for identifying patients with active pulmonary TB varied from 81% to 100%; specificity ranged from 19% to 84%.
Our analysis suggests that clinicians can use prediction rules to identify patients with very low risk of infection among those suspected for TB on admission to the hospital, and thus reduce isolation of patients without TB.

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    ABSTRACT: Background Effective protocols for the isolation and de-isolation of patients with suspected pulmonary tuberculosis (PTB) are essential determinants of health-care costs. Early de-isolation needs to be balanced with the need to prevent nosocomial transmission of PTB. The aim of our study was to evaluate the efficiency of our hospital¿s current protocol for isolating and de-isolating patients with suspected PTB, in particular assessing the timeliness to de-isolation of patients with AFB smear negative respiratory samples.Methods We retrospectively reviewed 121 patients with suspected PTB who were admitted to our hospital¿s isolation ward. We analyzed the time spent in isolation, the total number of respiratory samples that were collected for each patient and the time taken from collection of the first respiratory sample to release of the result of third respiratory sample for acid-fast bacilli (AFB) smear. We also calculated the direct cost of isolation for each patient.ResultsThe mean and median number of AFB smears for each patient was three. Thirty percent of patients had four or more AFB smears taken and 20% were de-isolated before the results of three negative AFB smears were obtained. The mean duration of isolation was significantly shorter in patients who had fewer than three negative AFB smears compared to those who had three or more negative AFB smears (three days vs. five days, p <0.01). The mean cost in patients who were de-isolated before three negative smears were obtained was USD 947 compared to USD 1,636 in those were only de-isolated after three negative AFB smears (p <0.01).Conclusions Our study suggests that our institution¿s current infection control policy for the isolation of patients with suspected PTB is fairly satisfactory, but may need to be tightened further to prevent true cases of PTB being de-isolated prematurely. However, there may be instances when patients could potentially be de-isolated more quickly without risk to others, thus saving on the use of limited resources and costs to patients.
    BMC Infectious Diseases 10/2014; 14(1):547. DOI:10.1186/s12879-014-0547-7 · 2.56 Impact Factor
  • Infectious Disease in Clinical Practice 01/2009; 17(5):291-292. DOI:10.1097/IPC.0b013e3181b7b212
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    ABSTRACT: SETTINGLuigi Sacco Hospital, Milan, Italy, 1 January 2000–31 December 2010. OBJECTIVES To develop a predictive score for identifying human immunodeficiency virus (HIV) infected patients with pulmonary tuberculosis (PTB). DESIGNRetrospective study based on the medical charts of HIV-infected patients admitted consecutively on presumption of PTB. Patients with culture-positive TB were included in the TB group. Culture-negative subjects formed the non-TB group. Risk factors for PTB were identified and a predictive model was developed. The diagnostic test accuracy of the derived score and that of previously developed scores were analysed. RESULTSA total of 65 patients were included in the TB group and 505 subjects in the non-TB group. An eight-variable model (age, origin, alcohol use, respiratory rate, weight loss, haemoglobin, white blood cell count, typical chest X-ray) was derived. When compared with the different scores, this model showed the greatest area under the receiver operating characteristic curve (0.880). This score was the only one to present a negative likelihood ratio of CONCLUSIONS This model may be useful in predicting PTB in HIV patients in low-endemic countries. A validation study is necessary.
    The International Journal of Tuberculosis and Lung Disease 07/2014; 18(7):831-6. DOI:10.5588/ijtld.13.0588 · 2.76 Impact Factor

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