Author | Gonçalves, Berenice das Dores | |
Author | Passos, Sonia Regina Lambert | |
Author | Santos, Maria Angelica Borges dos | |
Author | Andrade, Carlos Augusto Ferreira de | |
Author | Martins, Maria de Fátima Moreira | |
Author | Mello, Fernanda Carvalho de Queiroz | |
Access date | 2019-08-19T14:14:19Z | |
Available date | 2019-08-19T14:14:19Z | |
Document date | 2015 | |
Citation | GONÇALVES, Berenice das Dores et al. Systematic review with meta-analyses and critical appraisal of clinical prediction rules for pulmonary tuberculosis in hospitals. Infection Control and Hospital Epidemiology, v. 36, n. 2, p. 204-213, 2015. | en_US |
ISSN | 0899-823X | |
URI | https://www.arca.fiocruz.br/handle/icict/34873 | |
Language | eng | en_US |
Publisher | Cambridge University Press | en_US |
Rights | open access | en_US |
Title | Systematic review with meta-analyses and critical appraisal of clinical prediction rules for pulmonary tuberculosis in hospitals | en_US |
Type | Article | en_US |
DOI | 10.1017/ice.2014.29 | |
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. | en_US |
Affilliation | Federal University Fluminense, Niterói, RJ, Brazil | en_US |
Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Epidemiologia Clínica. Rio de Janeiro, RJ, Brasil. | en_US |
Affilliation | Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Rio de Janeiro, RJ, Brasil. | en_US |
Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Epidemiologia Clínica. Rio de Janeiro, RJ, Brasil. | en_US |
Affilliation | Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil. | en_US |
Affilliation | Federal University of Rio de Janeiro. Medical School. Thoracic Diseases Institute. Rio de Janeiro, RJ, Brazil. | en_US |
Subject | Pulmonary tuberculosis | en_US |
Subject | Hospitals | en_US |
Subject | Clinical prediction rules | en_US |
e-ISSN | 1559-6834 | |
Embargo date | 2020-02-19 | |