table 1. Clinical Prediction Rules for Detection of Pulmonary Tuberculosis among Patients Admitted to Acute Care Hospitalsa
Author (Year Published)
Bock (1996)35
Study Location and Design
Atlanta, prospective cohort; patients admitted to respiratory isolation
Gaeta (1997)36
Bronx, case-control (derivation) retrospective cohort
(validation); patients admitted from emergency department for pneumonia
El Solh (1997)37 Buffalo, retrospective cohort (derivation and validation); patients admitted to respiratory isolation
Wisnivesky, (2000)38 and (2005)39
New York City, case-control, 2000 (derivation); cases with culture- positive TB isolated on admission were compared to controls who were isolated on admission Prospective cohort, 2005 (validation); patients admitted to respiratory isolation
TB Risk Factors
Knowing someone with active TB, self-reported INH preventive therapy, self-reported history of positive TST
HIV positive or unknown HIV status and IDU; TST conversion ≤2 years, exposure to patient with pulmonary TB, previous TB history,
hemoptysis …
Clinical Symptoms or Signs
…
Radiographic or Laboratory Findings
Upper lobe infiltrate, cavity on CXR
Sensitivity %, Specificity %
81, 62
PPV %, NPV %, Comment 26, 95
Positive≥1 point
…
CXR with either apical density, upper lobe infiltrate, or cavity
96, 14 (valid cohort) 23, 92 (valid cohort) Positive≥1 point
Fever ≥2 weeks, weight loss >10% IBW in the past 6 mo
TB risk factors (recent immigrant, history of exposure to TB patient, resident of prison, shelter or nursing home in last 3 years) or chronic symptoms (4)a; positive TST (5)
Chronic symptoms of weight loss, malaise, weakness, and night sweats for >3mo OR TB risk factors (4); Shortness of breath (
− − 3); Temp=
38.5–39.0°C (3); Temp >39.0°C (6); crackles (
3);
Upper zone disease on CXR; CD4 count <200 cells/mm3 in previous 3 months
Upper lobe
consolidation on CXR (6)
100, 50 (valid cohort) 10, 100 (valid cohort) Positive=any criteria: upper zone disease; fever and weight loss; or fever and CD4 count <200 cells/mm3 Positive≥1 point
98, 46 (case-control) 95, 35 (valid cohort)
3, 99 (case-control) 10, 99 (valid cohort)
naats and clinical prediction rules for tb in acute care 1217
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