SETTING: A pediatric ward of a university hospital in Kigali, Rwanda, a region with a high HIV seroprevalence. OBJECTIVE: To estimate the diagnostic accuracy of symptoms, signs, and paraclinical investigations for tuberculosis in children, and to propose a clinical rule based on the results. DESIGN: During a 2-year period all children with cough for more than 2 weeks and/or fever for more than 2 weeks and/or reported weight loss were prospectively included. A set of clinical and paraclinical data were analyzed with latent class analysis. Comparison of post-test probability based on this analysis with a therapeutic threshold for TB was used to develop a guideline. RESULTS: In the 309 children HIV prevalence was 56%, bacteriology was positive in 9%, and the tuberculin skin test (TST) was >10 mm in 20%. TB prevalence was 32%. Bacteriology and TST had a specificity of 97% and cough had a sensitivity of 91%. Decision analysis suggests treating children presenting one of the inclusion criteria, combined with positive bacteriology or TST >10 mm or contact with a TB patient. CONCLUSIONS: Latent class analysis confirmed earlier identified predictors for TB and allowed development of an easy to use clinical rule, applicable in reference hospitals of countries with high HIV endemicity.
SETTING: A pediatric ward of a university hospital in Kigali, Rwanda, a region with a high HIV seroprevalence. OBJECTIVE: To estimate the diagnostic accuracy of symptoms, signs, and paraclinical investigations for tuberculosis in children, and to propose a clinical rule based on the results. DESIGN: During a 2-year period all children with cough for more than 2 weeks and/or fever for more than 2 weeks and/or reported weight loss were prospectively included. A set of clinical and paraclinical data were analyzed with latent class analysis. Comparison of post-test probability based on this analysis with a therapeutic threshold for TB was used to develop a guideline. RESULTS: In the 309 children HIV prevalence was 56%, bacteriology was positive in 9%, and the tuberculin skin test (TST) was >10 mm in 20%. TB prevalence was 32%. Bacteriology and TST had a specificity of 97% and cough had a sensitivity of 91%. Decision analysis suggests treating children presenting one of the inclusion criteria, combined with positive bacteriology or TST >10 mm or contact with a TBpatient. CONCLUSIONS: Latent class analysis confirmed earlier identified predictors for TB and allowed development of an easy to use clinical rule, applicable in reference hospitals of countries with high HIV endemicity.
Authors: Samuel G Schumacher; Maarten van Smeden; Nandini Dendukuri; Lawrence Joseph; Mark P Nicol; Madhukar Pai; Heather J Zar Journal: Am J Epidemiol Date: 2016-10-13 Impact factor: 4.897
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Authors: Tania A Thomas; Scott K Heysell; Prashini Moodley; Romualde Montreuil; Xia Ha; Gerald Friedland; Sheila A Bamber; Anthony P Moll; Neel Gandhi; William E Brant; Willem Sturm; Sarita Shah Journal: BMC Infect Dis Date: 2014-01-09 Impact factor: 3.090
Authors: Fabián A Jaimes; Gisela D De La Rosa; Marta L Valencia; Clara M Arango; Carlos I Gomez; Alex Garcia; Sigifredo Ospina; Susana C Osorno; Adriana I Henao Journal: BMC Anesthesiol Date: 2013-09-19 Impact factor: 2.217