1220 infection control & hospital epidemiology october 2015, vol. 36, no. 10 Tuberculosis Screening Form
To be used among adults without human immunodeficiency virus infection being admitted and considered for placement in an airborne infection isolation room (AIIR) for possible tuberculosis (TB).
If the total score is ≥4, admit to AIIR and pursue diagnostic evaluation for TB according to procedures such as those in Figure 2.
Characteristics Chronic symptoms for > 2 weeksa
– Weight loss – Persistent fevers – Malaise – Night sweats
Immunosuppressionb – Chronic liver disease
– Chronic kidney disease – Diabetes mellitus – Active cancer of any type – Steroid or other immunosuppressive drug in past 3 months
– Alcoholism Foreign birth
Chest radiograph with upper zone findings Shortness of breath
2 2 -2 Total Score
aIf a patient has any of the chronic symptoms listed for > 2 weeks are checked, then 6 points should be entered on the screening form.
bIf a patient has any of the immunosuppressing conditions listed, then 4 points should be entered on the screening form.
figure 1. Example clinical prediction rule based on Rakoczy et al.41
for detection of pulmonary TB and rifampin resistance have been published.53,54 Compared with patients with negative AFB sputumsmears, patients with positive smears had higher pooled sensitivity estimates (98% vs 68%); pooled specificity estimates were 99% for patients with both positive and negative AFB sputum smears.53,54 Using cultures and drug susceptibility tests as a gold standard, the Xpert assay had a pooled sensitivity of 95% and specificity of 98% for detecting rifampin resis- tance.53,54 Becausemost studies included in themeta-analyses of the Xpert assay were conducted in countries with a high TB burden,53,54 the positive predictive value of this assay may be lower in the United States. However, because the sensitivity of the Xpert assay is higher than the AFB smear, the negative predictive value of the Xpert assay is >99%insettingsofboth low and high TB burden.55 Therefore, a negative result on an Xpert assay provides high accuracy in excluding TB. The diagnostic performance of NAATs is influenced by the clinical suspicion of the healthcare provider regarding TB.
Many studies conducted in low56,57 and high TB burden58,59 countries have demonstrated that sensitivity and specificity of NAATs is significantly lower among patients whose healthcare providers had a low clinical suspicion for TB compared with those patients with a high or moderate suspicion for TB. These differences in performance of NAATs by level of clinical suspi- cion have also been noted for patients with AFB smear-negative pulmonary TB.59 NAATs should not be used for patients who are being treated for TB and should be used with caution among patients previously treated for TB because NAATs can remain persistently positive following curative treatment.60,61
Impact of NAATs on Reducing Utilization of AIIRs and Improving Clinical Care
Cohort studies conducted in US acute care facilities have provided evidence to support the use of NAATs to reduce the use of AIIRs.9,10,62–64 In our review, 3 studies used a
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