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

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Authors
Solari, Lely
Soto, Alonso
Van der Stuyft, Patrick
Issue Date
2017-10
Keywords
Adenosine deaminase activity
Mycobacterium tuberculosis
Pleural tuberculosis
Score
Cells and cell components
Chemical analysis
xmlui.metadata.dc.contributor.email
alonso.soto@upc.edu.pe

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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
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.
ISSN
13602276
ae974a485f413a2113503eed53cd6c53
10.1111/tmi.12932
Scopus Count
Collections
Medicina

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