Performance of clinical prediction rules for diagnosis of pleural tuberculosis in a high-incidence setting

2.50
Hdl Handle:
http://hdl.handle.net/10757/622276
Title:
Performance of clinical prediction rules for diagnosis of pleural tuberculosis in a high-incidence setting
Authors:
Solari, Lely; Soto, Alonso; Van der Stuyft, Patrick
Citation:
Performance of clinical prediction rules for diagnosis of pleural tuberculosis in a high-incidence setting 2017, 22 (10):1283 Tropical Medicine & International Health
Publisher:
John Wiley & Sons Ltd
Journal:
Tropical Medicine & International Health
Issue Date:
Oct-2017
URI:
http://hdl.handle.net/10757/622276
DOI:
10.1111/tmi.12932
Additional Links:
http://doi.wiley.com/10.1111/tmi.12932
Abstract:
Objectives: Diagnosis of pleural tuberculosis (PT) is still a challenge, particularly in resource-constrained settings. Alternative diagnostic tools are needed. We aimed at evaluating the utility of Clinical Prediction Rules (CPRs) for diagnosis of pleural tuberculosis in Peru. Methods: We identified CPRs for diagnosis of PT through a structured literature search. CPRs using high-complexity tests, as defined by the FDA, were excluded. We applied the identified CPRs to patients with pleural exudates attending two third-level hospitals in Lima, Peru, a setting with high incidence of tuberculosis. Besides pleural fluid analysis, patients underwent closed pleural biopsy for reaching a final diagnosis through combining microbiological and histopathological criteria. We evaluated the performance of the CPRs against this composite reference standard using classic indicators of diagnostic test validity. Results: We found 15 eligible CPRs, of which 12 could be validated. Most included ADA, age, lymphocyte proportion and protein in pleural fluid as predictive findings. A total of 259 patients were included for their validation, of which 176 (67%) had PT and 50 (19%) malignant pleural effusion. The overall accuracy of the CPRs varied from 41% to 86%. Two had a positive likelihood ratio (LR) above 10, but none a negative LR below 0.1. ADA alone at a cut-off of ≥40 IU attained 87% diagnostic accuracy and had a positive LR of 6.6 and a negative LR of 0.2. Conclusion: Many CPRs for PT are available. In addition to ADA alone, none of them contributes significantly to diagnosis of PT.
Type:
info:eu-repo/semantics/article
Rights:
info:eu-repo/semantics/openAccess
Language:
eng
Description:
El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.
Keywords:
Adenosine deaminase activity; Mycobacterium tuberculosis; Pleural tuberculosis; Score; Cells and cell components; Chemical analysis
ISSN:
13602276
Email:
alonso.soto@upc.edu.pe

Full metadata record

DC FieldValue Language
dc.contributor.authorSolari, Lelyes
dc.contributor.authorSoto, Alonsoes
dc.contributor.authorVan der Stuyft, Patrickes
dc.date.accessioned2017-10-21T15:20:00Z-
dc.date.available2017-10-21T15:20:00Z-
dc.date.issued2017-10-
dc.identifier.citationPerformance of clinical prediction rules for diagnosis of pleural tuberculosis in a high-incidence setting 2017, 22 (10):1283 Tropical Medicine & International Healthes
dc.identifier.issn13602276-
dc.identifier.doi10.1111/tmi.12932-
dc.identifier.urihttp://hdl.handle.net/10757/622276-
dc.descriptionEl texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.es_PE
dc.description.abstractObjectives: Diagnosis of pleural tuberculosis (PT) is still a challenge, particularly in resource-constrained settings. Alternative diagnostic tools are needed. We aimed at evaluating the utility of Clinical Prediction Rules (CPRs) for diagnosis of pleural tuberculosis in Peru. Methods: We identified CPRs for diagnosis of PT through a structured literature search. CPRs using high-complexity tests, as defined by the FDA, were excluded. We applied the identified CPRs to patients with pleural exudates attending two third-level hospitals in Lima, Peru, a setting with high incidence of tuberculosis. Besides pleural fluid analysis, patients underwent closed pleural biopsy for reaching a final diagnosis through combining microbiological and histopathological criteria. We evaluated the performance of the CPRs against this composite reference standard using classic indicators of diagnostic test validity. Results: We found 15 eligible CPRs, of which 12 could be validated. Most included ADA, age, lymphocyte proportion and protein in pleural fluid as predictive findings. A total of 259 patients were included for their validation, of which 176 (67%) had PT and 50 (19%) malignant pleural effusion. The overall accuracy of the CPRs varied from 41% to 86%. Two had a positive likelihood ratio (LR) above 10, but none a negative LR below 0.1. ADA alone at a cut-off of ≥40 IU attained 87% diagnostic accuracy and had a positive LR of 6.6 and a negative LR of 0.2. Conclusion: Many CPRs for PT are available. In addition to ADA alone, none of them contributes significantly to diagnosis of PT.es
dc.formatapplication/pdfes
dc.language.isoenges
dc.publisherJohn Wiley & Sons Ltdes
dc.relation.urlhttp://doi.wiley.com/10.1111/tmi.12932es
dc.rightsinfo:eu-repo/semantics/openAccesses
dc.subjectAdenosine deaminase activityes
dc.subjectMycobacterium tuberculosises
dc.subjectPleural tuberculosises
dc.subjectScorees
dc.subjectCells and cell componentses
dc.subjectChemical analysises
dc.titlePerformance of clinical prediction rules for diagnosis of pleural tuberculosis in a high-incidence settinges
dc.typeinfo:eu-repo/semantics/articlees
dc.identifier.journalTropical Medicine & International Healthes
dc.contributor.institutionUnit of General Epidemiology and Disease Control; Institute of Tropical Medicine of Antwerp; Antwerp Belgium-
dc.contributor.institutionEscuela de Medicina; Universidad Peruana de Ciencias Aplicadas; Lima Peru-
dc.contributor.institutionUnit of General Epidemiology and Disease Control; Institute of Tropical Medicine of Antwerp; Antwerp Belgium-
dc.description.peerreviewRevisión por pareses_PE
dc.contributor.emailalonso.soto@upc.edu.pees_PE
All Items in UPC are protected by copyright, with all rights reserved, unless otherwise indicated.