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Validity of clinical prediction rules for isolating inpatients with suspected tuberculosis

A systematic review

Journal of General Internal Medicine volume 20, pages 947–952 (2005)Cite this article

Abstract

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.

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Affiliations

  1. Division of General Internal Medicine, Mount Sinai Medical Center, New York, NY, USA

    Juan P. Wisnivesky MD, MPH, Carlton Moore MD & Thomas McGinn MD, MPH

  2. Division of Pulmonary, Critical Care Medicine, and Sleep Medicine, Mount Sinai Medical Center, New York, NY, USA

    Juan P. Wisnivesky MD, MPH & Michael C. Iannuzzi MD, MBA

  3. Department of Pediatrics, Jacobi Medical Center, Bronx, NY, USA

    Denise Serebrisky MD

  4. Department of Community and Preventive Medicine, Mount Sinai Medical Center, New York, NY, USA

    Henry S. Sacks MD, PhD

Authors
  1. Juan P. Wisnivesky MD, MPH
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  2. Denise Serebrisky MD
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  3. Carlton Moore MD
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  4. Henry S. Sacks MD, PhD
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  5. Michael C. Iannuzzi MD, MBA
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  6. Thomas McGinn MD, MPH
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Correspondence to Juan P. Wisnivesky MD, MPH.

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The authors have no financial conflicts of interest to report.

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Wisnivesky, J.P., Serebrisky, D., Moore, C. et al. Validity of clinical prediction rules for isolating inpatients with suspected tuberculosis. J GEN INTERN MED 20, 947–952 (2005). https://doi.org/10.1111/j.1525-1497.2005.0185.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2005.0185.x

Key Words

  • tuberculosis
  • diagnosis
  • clinical prediction rules
  • systematic review