Rupesh Agrawal1,2,3,4,5, Zhang Ludi6, Bjorn K Betzler7, Ilaria Testi8, Sarakshi Mahajan9, Andres Rousellot10, John H Kempen11,12,13,14, Justine R Smith15,16, Peter McCluskey17, Quan Dong Nguyen18, Carlos Pavesio8, Vishali Gupta19. 1. National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore. rupesh_agrawal@ttsh.com.sg. 2. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. rupesh_agrawal@ttsh.com.sg. 3. Duke NUS Medical School, Singapore, Singapore. rupesh_agrawal@ttsh.com.sg. 4. Singapore Eye Research Institute, Singapore, Singapore. rupesh_agrawal@ttsh.com.sg. 5. National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK. rupesh_agrawal@ttsh.com.sg. 6. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. 7. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 8. National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK. 9. St Joseph Mercy Hospital, Oakland, Pontiac, MI, USA. 10. Ciudad Autónoma de Buenos Aires, Consultorios Oftalmológicos Benisek-Ascarza, Buenos Aires, Argentina. 11. Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear/Harvard Medical School, Boston, MA, USA. 12. Sight for Souls, Fort Myers, FL, USA. 13. Department of Ophthalmology, Addis Ababa University, Addis Ababa, Ethiopia. 14. MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital, MyungSung Medical School, Addis Ababa, Ethiopia. 15. Flinders University College of Medicine & Public Health, Adelaide, SA, Australia. 16. Queensland Eye Institute, Brisbane, QLD, Australia. 17. Save Sight Institute, Department of Ophthalmology, The University of Sydney, Sydney, NSW, Australia. 18. Byers Eye Institute, Stanford Medical School, Palo alto, CA, USA. 19. Advanced Eye Centre, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. vishalisara@gmail.com.
Abstract
OBJECTIVE: To introduce the Collaborative Ocular Tuberculosis Study (COTS) Calculator, an online clinical scoring system for initiating antitubercular therapy (ATT) in patients with ocular tuberculosis (TB). METHOD: The COTS Calculator was derived from COTS Consensus (COTS CON) data, which has previously published consensus guidelines. Using a two-step Delphi method, 81 experts evaluated 486 clinical scenario-based questions, ranking their likelihood of initiating ATT in each specific scenario. Each scenario was a permutation of the results and/or availability of five following components-clinical phenotype, endemicity, two immunological (tuberculin skin test, interferon-γ release assay) and one radiological (chest X-Ray) test results-and a sixth component further stratifying three of the clinical phenotypes. The median scores and interquartile ranges (IQR) of each scenario were tabulated, representing the expert consensus on whether to initiate ATT in that scenario. The consensus table was encoded to develop the COTS Calculator. RESULTS: The COTS Calculator can be accessed online at: https://www.oculartb.net/cots-calc . The attending physician can select the conditions present in the patient, which will generate a median score from 1 to 5. 114 out of 486 scenarios (24%) deliberated had a median score of 5 indicating expert consensus to initiate ATT. CONCLUSION: The COTS Calculator is an efficient, low-cost, evidence and experience-based clinical tool to guide ATT initiation. While it holds substantial promise in improving standard-of-care for ocular-TB patients, future validation studies can help to as certain its clinical utility and reliability.
OBJECTIVE: To introduce the Collaborative Ocular Tuberculosis Study (COTS) Calculator, an online clinical scoring system for initiating antitubercular therapy (ATT) in patients with ocular tuberculosis (TB). METHOD: The COTS Calculator was derived from COTS Consensus (COTS CON) data, which has previously published consensus guidelines. Using a two-step Delphi method, 81 experts evaluated 486 clinical scenario-based questions, ranking their likelihood of initiating ATT in each specific scenario. Each scenario was a permutation of the results and/or availability of five following components-clinical phenotype, endemicity, two immunological (tuberculin skin test, interferon-γ release assay) and one radiological (chest X-Ray) test results-and a sixth component further stratifying three of the clinical phenotypes. The median scores and interquartile ranges (IQR) of each scenario were tabulated, representing the expert consensus on whether to initiate ATT in that scenario. The consensus table was encoded to develop the COTS Calculator. RESULTS: The COTS Calculator can be accessed online at: https://www.oculartb.net/cots-calc . The attending physician can select the conditions present in the patient, which will generate a median score from 1 to 5. 114 out of 486 scenarios (24%) deliberated had a median score of 5 indicating expert consensus to initiate ATT. CONCLUSION: The COTS Calculator is an efficient, low-cost, evidence and experience-based clinical tool to guide ATT initiation. While it holds substantial promise in improving standard-of-care for ocular-TB patients, future validation studies can help to as certain its clinical utility and reliability.