Diagnostic accuracy of an integrated respiratory guideline in identifying patients with respiratory symptoms requiring screening for pulmonary tuberculosis: a cross-sectional study

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dc.contributor.authorEnglish, Reneen_ZA
dc.contributor.authorBachmann, Maxen_ZA
dc.contributor.authorBateman, Ericen_ZA
dc.contributor.authorZwarenstein, Merricken_ZA
dc.contributor.authorFairall, Laraen_ZA
dc.contributor.authorBheekie, Angenien_ZA
dc.contributor.authorMajara, Bosieloen_ZA
dc.contributor.authorLombard, Carlen_ZA
dc.contributor.authorScherpbier, Roberten_ZA
dc.contributor.authorOttomani, Salahen_ZA
dc.date.accessioned2015-10-12T10:53:42Z
dc.date.available2015-10-12T10:53:42Z
dc.date.issued2006en_ZA
dc.description.abstractBACKGROUND:To evaluate the diagnostic accuracy of the integrated Practical Approach to Lung Health in South Africa (PALSA) guideline in identifying patients requiring bacteriological screening for tuberculosis (TB), and to determine which clinical features best predict suspected and bacteriologically-confirmed tuberculosis among patients with respiratory symptoms. METHODS: A prospective, cross-sectional study in which 1392 adult patients with cough and/or difficult breathing, attending a primary care facility in Cape Town, South Africa, were evaluated by a nurse using the guideline. The accuracy of a nurse using the guideline to identify TB suspects was compared to that of primary care physicians' diagnoses of (1) suspected TB, and (2) proven TB supported by clinical information and chest radiographs. RESULTS: The nurse using the guideline identified 516 patients as TB suspects compared with 365 by the primary care physicians, representing a sensitivity of 76% (95% confidence interval (CI) 71%-79%), specificity of 77% (95% CI 74%-79%), positive predictive value of 53% (95% CI 49%-58%), negative predictive value of 90% (95% CI 88%-92%), and area under the receiver operating characteristic curve (ARUC) of 0.76 (95% CI 0.74-0.79). Sputum results were obtained in 320 of the 365 primary care physicians TB suspects (88%); 40 (13%) of these were positive for TB. Only 4 cases were not identified by the nurse using the guideline. The primary care physicians diagnostic accuracy in diagnosing bacteriologically-confirmed TB (n = 320) was as follows: sensitivity 90% (95% CI 76%-97%), specificity 65% (95% CI 63%-68%), negative predictive value 7% (95% CI 5%-10%), positive predictive value 99.5% (95% CI 98.8%-99.8%), and ARUC 0.78 (95% CI 0.73-0.82). Weight loss, pleuritic pain, and night sweats were independently associated with the diagnosis of bacteriologically-confirmed tuberculosis (positive likelihood ratio if all three present = 16.7, 95% CI 5.9-29.4). CONCLUSION: The PALSA guideline is an effective screening tool for identifying patients requiring bacteriological screening for pulmonary tuberculosis in this primary care setting. This supports the randomized trial finding that use of the guideline increased TB case detection.en_ZA
dc.identifier.apacitationEnglish, R., Bachmann, M., Bateman, E., Zwarenstein, M., Fairall, L., Bheekie, A., ... Ottomani, S. (2006). Diagnostic accuracy of an integrated respiratory guideline in identifying patients with respiratory symptoms requiring screening for pulmonary tuberculosis: a cross-sectional study. <i>BMC Pulmonary Medicine</i>, http://hdl.handle.net/11427/14175en_ZA
dc.identifier.chicagocitationEnglish, Rene, Max Bachmann, Eric Bateman, Merrick Zwarenstein, Lara Fairall, Angeni Bheekie, Bosielo Majara, Carl Lombard, Robert Scherpbier, and Salah Ottomani "Diagnostic accuracy of an integrated respiratory guideline in identifying patients with respiratory symptoms requiring screening for pulmonary tuberculosis: a cross-sectional study." <i>BMC Pulmonary Medicine</i> (2006) http://hdl.handle.net/11427/14175en_ZA
dc.identifier.citationEnglish, R. G., Bachmann, M. O., Bateman, E. D., Zwarenstein, M. F., Fairall, L. R., Bheekie, A., ... & Ottomani, S. E. (2006). Diagnostic accuracy of an integrated respiratory guideline in identifying patients with respiratory symptoms requiring screening for pulmonary tuberculosis: a cross-sectional study. BMC Pulmonary Medicine, 6(1), 22.en_ZA
dc.identifier.ris TY - Journal Article AU - English, Rene AU - Bachmann, Max AU - Bateman, Eric AU - Zwarenstein, Merrick AU - Fairall, Lara AU - Bheekie, Angeni AU - Majara, Bosielo AU - Lombard, Carl AU - Scherpbier, Robert AU - Ottomani, Salah AB - BACKGROUND:To evaluate the diagnostic accuracy of the integrated Practical Approach to Lung Health in South Africa (PALSA) guideline in identifying patients requiring bacteriological screening for tuberculosis (TB), and to determine which clinical features best predict suspected and bacteriologically-confirmed tuberculosis among patients with respiratory symptoms. METHODS: A prospective, cross-sectional study in which 1392 adult patients with cough and/or difficult breathing, attending a primary care facility in Cape Town, South Africa, were evaluated by a nurse using the guideline. The accuracy of a nurse using the guideline to identify TB suspects was compared to that of primary care physicians' diagnoses of (1) suspected TB, and (2) proven TB supported by clinical information and chest radiographs. RESULTS: The nurse using the guideline identified 516 patients as TB suspects compared with 365 by the primary care physicians, representing a sensitivity of 76% (95% confidence interval (CI) 71%-79%), specificity of 77% (95% CI 74%-79%), positive predictive value of 53% (95% CI 49%-58%), negative predictive value of 90% (95% CI 88%-92%), and area under the receiver operating characteristic curve (ARUC) of 0.76 (95% CI 0.74-0.79). Sputum results were obtained in 320 of the 365 primary care physicians TB suspects (88%); 40 (13%) of these were positive for TB. Only 4 cases were not identified by the nurse using the guideline. The primary care physicians diagnostic accuracy in diagnosing bacteriologically-confirmed TB (n = 320) was as follows: sensitivity 90% (95% CI 76%-97%), specificity 65% (95% CI 63%-68%), negative predictive value 7% (95% CI 5%-10%), positive predictive value 99.5% (95% CI 98.8%-99.8%), and ARUC 0.78 (95% CI 0.73-0.82). Weight loss, pleuritic pain, and night sweats were independently associated with the diagnosis of bacteriologically-confirmed tuberculosis (positive likelihood ratio if all three present = 16.7, 95% CI 5.9-29.4). CONCLUSION: The PALSA guideline is an effective screening tool for identifying patients requiring bacteriological screening for pulmonary tuberculosis in this primary care setting. This supports the randomized trial finding that use of the guideline increased TB case detection. DA - 2006 DB - OpenUCT DO - 10.1186/1471-2466-6-22 DP - University of Cape Town J1 - BMC Pulmonary Medicine LK - https://open.uct.ac.za PB - University of Cape Town PY - 2006 T1 - Diagnostic accuracy of an integrated respiratory guideline in identifying patients with respiratory symptoms requiring screening for pulmonary tuberculosis: a cross-sectional study TI - Diagnostic accuracy of an integrated respiratory guideline in identifying patients with respiratory symptoms requiring screening for pulmonary tuberculosis: a cross-sectional study UR - http://hdl.handle.net/11427/14175 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14175
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2466-6-22
dc.identifier.vancouvercitationEnglish R, Bachmann M, Bateman E, Zwarenstein M, Fairall L, Bheekie A, et al. Diagnostic accuracy of an integrated respiratory guideline in identifying patients with respiratory symptoms requiring screening for pulmonary tuberculosis: a cross-sectional study. BMC Pulmonary Medicine. 2006; http://hdl.handle.net/11427/14175.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDivision of Pulmonologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Pulmonary Medicineen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcpulmmed/en_ZA
dc.subject.otherRespiratory Researchen_ZA
dc.titleDiagnostic accuracy of an integrated respiratory guideline in identifying patients with respiratory symptoms requiring screening for pulmonary tuberculosis: a cross-sectional studyen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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