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Systematic Review With Meta-Analyses and Critical Appraisal of Clinical Prediction Rules for Pulmonary Tuberculosis in Hospitals

Published online by Cambridge University Press:  18 December 2014

Berenice das Dores Gonçalves ,
Sonia Regina Lambert Passos ,
Maria Angelica Borges dos Santos ,
Carlos Augusto Ferreira de Andrade ,
Maria de Fátima Moreira Martins  and
Fernanda Carvalho de Queiroz Mello
Berenice das Dores Gonçalves*
Affiliation:
Federal University Fluminense, Niterói, RJ, Brazil
Sonia Regina Lambert Passos
Affiliation:
National Institute of Infectious Disease EvandroChagas/Oswaldo Cruz Foundation/Laboratory of Clinical Epidemiology, Rio de Janeiro, RJ, Brazil
Maria Angelica Borges dos Santos
Affiliation:
National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
Carlos Augusto Ferreira de Andrade
Affiliation:
National Institute of Infectious Disease EvandroChagas/Oswaldo Cruz Foundation/Laboratory of Clinical Epidemiology, Rio de Janeiro, RJ, Brazil
Maria de Fátima Moreira Martins
Affiliation:
Oswaldo Cruz Foundation Libraries’ Network/ Institute of Scientific and Technological Information and Communication in Health/ Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
Fernanda Carvalho de Queiroz Mello
Affiliation:
Thoracic Diseases Institute, Medical School of the Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
*
Address correspondence to Berenice das Dores Gonçalves, MSc, Department of Epidemiology and Biostatistics, Fluminense Federal University, Rua Marques Paraná 303, Prédio Anexo, 3o andar - sala 9 Centro, Niterói, RJ, CEP: 24030-210, Brasil (berenice@vm.uff.br).
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Abstract

Objective

To systematically review studies evaluating clinical prediction rules (CPRs) for adult inpatients suspected to have pulmonary tuberculosis.

Design

Systematic review with meta-analyses.

Setting

Hospitals.

Patients

Inpatients at least 15 years of age admitted to acute care.

Methods

A search was conducted in 5 indexed electronic databases with no language or year of publication restrictions. We performed a meta-analysis for those CPRs with at least 2 validation studies. Results were reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Results

Of the 461 abstracts selected, 36 articles were fully analyzed and 11 articles were included, yielding 8 CPRs derived in 4 countries. Broad validation studies were identified for 2 CPRs. The most frequent clinical predictors were fever and weight loss. All CPRs included chest imaging signs. Most CPRs were derived in countries with a low prevalence of pulmonary tuberculosis and included homeless, immigrants, and those who reacted to the purified protein derivative test. Both of the CPRs derived in countries with a high prevalence of pulmonary tuberculosis strongly relied on chest radiograph predictors. Accuracy of the different CPRs was high (area under receiver operating characteristic curve, 0.79–0.91). Meta-analysis of 4 validation studies for Wisnivesky´s CPR indicates optimistic pooled results: sensitivity, 94.1% (95% CI, 89.7%–96.7%); negative likelihood ratio, 0.22 (95% CI, 0.12–0.40).

Conclusion

On the basis of a critical appraisal of the 2 best validated CPRs, the presence of weight loss and/or fever in inpatients warrants obtaining a chest radiograph, regardless of the presence of productive cough. If the chest radiograph is abnormal, the patient should be placed in isolation until more specific test results are available. Validation in different settings is required to maximize external generalization of existing CPRs.

Infect Control Hosp Epidemiol 2014;00(0): 1–10

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 2 , February 2015 , pp. 204 - 213
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved 

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