Development of a simple reliable radiographic scoring system to aid the diagnosis of pulmonary tuberculosis

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dc.contributor.authorPinto, Lancelot Men_ZA
dc.contributor.authorDheda, Keertanen_ZA
dc.contributor.authorTheron, Granten_ZA
dc.contributor.authorAllwood, Brianen_ZA
dc.contributor.authorCalligaro, Gregoryen_ZA
dc.contributor.authorvan Zyl-Smit, Richarden_ZA
dc.contributor.authorPeter, Jonathanen_ZA
dc.contributor.authorSchwartzman, Kevinen_ZA
dc.contributor.authorMenzies, Dicken_ZA
dc.contributor.authorBateman, Ericen_ZA
dc.contributor.authorPai, Madhukaren_ZA
dc.contributor.authorDawson, Rodneyen_ZA
dc.date.accessioned2016-01-11T06:51:40Z
dc.date.available2016-01-11T06:51:40Z
dc.date.issued2013en_ZA
dc.description.abstractRationale: Chest radiography is sometimes the only method available for investigating patients with possible pulmonary tuberculosis (PTB) with negative sputum smears. However, interpretation of chest radiographs in this context lacks specificity for PTB, is subjective and is neither standardized nor reproducible. Efforts to improve the interpretation of chest radiography are warranted. Objectives To develop a scoring system to aid the diagnosis of PTB, using features recorded with the Chest Radiograph Reading and Recording System (CRRS). METHODS: Chest radiographs of outpatients with possible PTB, recruited over 3 years at clinics in South Africa were read by two independent readers using the CRRS method. Multivariate analysis was used to identify features significantly associated with culture-positive PTB. These were weighted and used to generate a score. RESULTS: 473 patients were included in the analysis. Large upper lobe opacities, cavities, unilateral pleural effusion and adenopathy were significantly associated with PTB, had high inter-reader reliability, and received 2, 2, 1 and 2 points, respectively in the final score. Using a cut-off of 2, scores below this threshold had a high negative predictive value (91.5%, 95%CI 87.1,94.7), but low positive predictive value (49.4%, 95%CI 42.9,55.9). Among the 382 TB suspects with negative sputum smears, 229 patients had scores <2; the score correctly ruled out active PTB in 214 of these patients (NPV 93.4%; 95%CI 89.4,96.3). The score had a suboptimal negative predictive value in HIV-infected patients (NPV 86.4, 95% CI 75,94). CONCLUSIONS: The proposed scoring system is simple, and reliably ruled out active PTB in smear-negative HIV-uninfected patients, thus potentially reducing the need for further tests in high burden settings. Validation studies are now required.en_ZA
dc.identifier.apacitationPinto, L. M., Dheda, K., Theron, G., Allwood, B., Calligaro, G., van Zyl-Smit, R., ... Dawson, R. (2013). Development of a simple reliable radiographic scoring system to aid the diagnosis of pulmonary tuberculosis. <i>PLoS One</i>, http://hdl.handle.net/11427/16253en_ZA
dc.identifier.chicagocitationPinto, Lancelot M, Keertan Dheda, Grant Theron, Brian Allwood, Gregory Calligaro, Richard van Zyl-Smit, Jonathan Peter, et al "Development of a simple reliable radiographic scoring system to aid the diagnosis of pulmonary tuberculosis." <i>PLoS One</i> (2013) http://hdl.handle.net/11427/16253en_ZA
dc.identifier.citationPinto, L. M., Dheda, K., Theron, G., Allwood, B., Calligaro, G., van Zyl-Smit, R., ... & Pai, M. (2013). Development of a simple reliable radiographic scoring system to aid the diagnosis of pulmonary tuberculosis. PloS one, 8(1), e54235. doi:10.1371/journal.pone.0054235en_ZA
dc.identifier.ris TY - Journal Article AU - Pinto, Lancelot M AU - Dheda, Keertan AU - Theron, Grant AU - Allwood, Brian AU - Calligaro, Gregory AU - van Zyl-Smit, Richard AU - Peter, Jonathan AU - Schwartzman, Kevin AU - Menzies, Dick AU - Bateman, Eric AU - Pai, Madhukar AU - Dawson, Rodney AB - Rationale: Chest radiography is sometimes the only method available for investigating patients with possible pulmonary tuberculosis (PTB) with negative sputum smears. However, interpretation of chest radiographs in this context lacks specificity for PTB, is subjective and is neither standardized nor reproducible. Efforts to improve the interpretation of chest radiography are warranted. Objectives To develop a scoring system to aid the diagnosis of PTB, using features recorded with the Chest Radiograph Reading and Recording System (CRRS). METHODS: Chest radiographs of outpatients with possible PTB, recruited over 3 years at clinics in South Africa were read by two independent readers using the CRRS method. Multivariate analysis was used to identify features significantly associated with culture-positive PTB. These were weighted and used to generate a score. RESULTS: 473 patients were included in the analysis. Large upper lobe opacities, cavities, unilateral pleural effusion and adenopathy were significantly associated with PTB, had high inter-reader reliability, and received 2, 2, 1 and 2 points, respectively in the final score. Using a cut-off of 2, scores below this threshold had a high negative predictive value (91.5%, 95%CI 87.1,94.7), but low positive predictive value (49.4%, 95%CI 42.9,55.9). Among the 382 TB suspects with negative sputum smears, 229 patients had scores <2; the score correctly ruled out active PTB in 214 of these patients (NPV 93.4%; 95%CI 89.4,96.3). The score had a suboptimal negative predictive value in HIV-infected patients (NPV 86.4, 95% CI 75,94). CONCLUSIONS: The proposed scoring system is simple, and reliably ruled out active PTB in smear-negative HIV-uninfected patients, thus potentially reducing the need for further tests in high burden settings. Validation studies are now required. DA - 2013 DB - OpenUCT DO - 10.1371/journal.pone.0054235 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - Development of a simple reliable radiographic scoring system to aid the diagnosis of pulmonary tuberculosis TI - Development of a simple reliable radiographic scoring system to aid the diagnosis of pulmonary tuberculosis UR - http://hdl.handle.net/11427/16253 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16253
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0054235
dc.identifier.vancouvercitationPinto LM, Dheda K, Theron G, Allwood B, Calligaro G, van Zyl-Smit R, et al. Development of a simple reliable radiographic scoring system to aid the diagnosis of pulmonary tuberculosis. PLoS One. 2013; http://hdl.handle.net/11427/16253.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_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 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2013 Pinto et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherSputumen_ZA
dc.subject.otherOpacityen_ZA
dc.subject.otherTuberculosis diagnosis and managementen_ZA
dc.subject.otherDiagnostic medicineen_ZA
dc.subject.otherHIV infectionsen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherTuberculosisen_ZA
dc.subject.otherPleural effusionen_ZA
dc.titleDevelopment of a simple reliable radiographic scoring system to aid the diagnosis of pulmonary tuberculosisen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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