OBJECTIVE: 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.
DATA SOURCES: 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.
REVIEW METHOD: Two reviewers independently assessed study quality and abstracted data regarding the sensitivity and specificity of the prediction
rules.
RESULTS: 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%.
CONCLUSIONS: 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.
Key Words tuberculosis - diagnosis - clinical prediction rules - systematic review
The authors have no financial conflicts of interest to report.
Presented at the 100th Annual International Conference of the American Thoracic Society, May 21 to 26, 2004, Orlando, Fla.