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Evaluation of clinical prediction rules for respiratory isolation of inpatients with suspected pulmonary tuberculosis

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dc.contributor.author Solari, L.
dc.contributor.author Acuna-Villaorduna, C.
dc.contributor.author Soto, A.
dc.contributor.author Van Der Stuyft, P.
dc.date.accessioned 2022-01-18T19:26:51Z
dc.date.available 2022-01-18T19:26:51Z
dc.date.issued 2011
dc.identifier.uri https://hdl.handle.net/20.500.12866/10943
dc.description.abstract Background: In the framework of hospital infection control, various clinical prediction rules (CPRs) for respiratory isolation of patients with suspected pulmonary tuberculosis (PTB) have been developed. Our aim was to evaluate their performance in an emergency department setting with a high prevalence of PTB. Methods: We searched the MEDLINE and OVID databases to identify CPRs to predict PTB. We used a previously collected database containing clinical, radiographical, and microbiological information on patients attending an emergency department with respiratory complaints, and we applied each CPR to every patient and compared the result with culture for Mycobacterium tuberculosis as the reference standard. We also simulated the proportion of isolated suspects and missed cases for PTB prevalences of 5% and 30%. Results: We withheld 13 CPRs for evaluation. We had complete data on 345 patients. Most CPRs achieved a high sensitivity but very low specificity and very low positive predictive value. Mylotte's score, which includes results of sputum smear as a predictive finding, was the best-performing CPR. It attained a sensitivity of 88.9% and a specificity of 63.9%. However, at a 30% PTB prevalence, 498 of 1000 individuals with suspected PTB would have to be isolated; 267 of these cases would be true PTB cases, and 33 cases would be missed. Two consecutive sputum smears had a sensitivity of 75.6% and a specificity of 99.7%. Conclusions: In a setting with a high prevalence of PTB, only 1 of the 13 assessed CPRs demonstrated high sensitivity combined with satisfactory specificity. Our results highlight the need for local validation of CPRs before their application. en_US
dc.language.iso eng
dc.publisher Oxford University Press
dc.relation.ispartofseries Clinical Infectious Diseases
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Controlled Study en_US
dc.subject Major Clinical Study en_US
dc.subject Prevalence en_US
dc.subject Infection Control en_US
dc.subject Mycobacterium Tuberculosis en_US
dc.subject Bacterium Culture en_US
dc.subject Lung Tuberculosis en_US
dc.subject Sputum Smear en_US
dc.subject Standard en_US
dc.subject Simulation en_US
dc.subject Medline en_US
dc.subject Patient Care en_US
dc.subject Respiratory Tract Disease en_US
dc.subject Data Base en_US
dc.subject Emergency Ward en_US
dc.subject Sensitivity And Sensibility en_US
dc.title Evaluation of clinical prediction rules for respiratory isolation of inpatients with suspected pulmonary tuberculosis en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1093/cid/ciq186
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.08
dc.relation.issn 1537-6591


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