| Título: | Performance of clinical prediction rules for diagnosis of pleural tuberculosis in a high-incidence setting |
| Autores: | Solari, Lely ; Soto, Alonso ; Van der Stuyft, Patrick |
| Tipo de documento: | texto impreso |
| Editorial: | John Wiley & Sons Ltd, 2017-10-21T15:20:00Z |
| Dimensiones: | application/pdf |
| Nota general: | info:eu-repo/semantics/openAccess |
| Idiomas: | Inglés |
| Palabras clave: | Facultad de Ciencias de la Salud , Pregrado , Artículos científicos , Medicina |
| Resumen: |
El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. Objectives: Diagnosis of pleural tuberculosis (PT) is still a challenge, particularly in resource-constrained settings. Alternative diagnostic tools are needed. We aimed at evaluating the utility of Clinical Prediction Rules (CPRs) for diagnosis of pleural tuberculosis in Peru. Methods: We identified CPRs for diagnosis of PT through a structured literature search. CPRs using high-complexity tests, as defined by the FDA, were excluded. We applied the identified CPRs to patients with pleural exudates attending two third-level hospitals in Lima, Peru, a setting with high incidence of tuberculosis. Besides pleural fluid analysis, patients underwent closed pleural biopsy for reaching a final diagnosis through combining microbiological and histopathological criteria. We evaluated the performance of the CPRs against this composite reference standard using classic indicators of diagnostic test validity. Results: We found 15 eligible CPRs, of which 12 could be validated. Most included ADA, age, lymphocyte proportion and protein in pleural fluid as predictive findings. A total of 259 patients were included for their validation, of which 176 (67%) had PT and 50 (19%) malignant pleural effusion. The overall accuracy of the CPRs varied from 41% to 86%. Two had a positive likelihood ratio (LR) above 10, but none a negative LR below 0.1. ADA alone at a cut-off of ?40 IU attained 87% diagnostic accuracy and had a positive LR of 6.6 and a negative LR of 0.2. Conclusion: Many CPRs for PT are available. In addition to ADA alone, none of them contributes significantly to diagnosis of PT. Revisión por pares |
| En línea: | Performance of clinical prediction rules for diagnosis of pleural tuberculosis in a high-incidence setting 2017, 22 (10):1283 Tropical Medicine & International Health |
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