Research Article

A Systematic Review of Clinical Diagnostic Systems Used in the Diagnosis of Tuberculosis in Children

Table 4

Studies attempting validation of diagnostic systems.

AuthorYearCountryScoring criteriaValidationGold standard

Point-based scoring systems

Mathur et al. [9]1974IndiaKenneth JonesSens 73% (original criteria)
Sens 95% (modified criteria)
Clinical diagnosis
Shah et al. [12]1992IndiaKenneth JonesCompared modified criteria to previous Kenneth JonesPrevious KJ
Mehnaz and Arif
[13]
2005PakistanKenneth JonesRetrospective analysisClinical control and response to treatment
Viani et al. [8]2008MexicoStegen-ToledoRetrospective analysisClinical diagnosis

van Beekhuizen [16]1998Papua New
Guinea
Keith EdwardsSens 62%, spec 95%Improvement on anti-TB treatment or positive CXR
Weismuller et al.
[17]
2002MalawiWHO score chart (modified Keith Edwards)Sens 61% for all types of TB; 54% for PTB and 73% for EPTBClinical diagnosis—differed by various hospitals
van Rheenen [18]2002ZambiaKeith EdwardsSens 88%, spec 25%, PPV 55%, NPV 67%Diagnostic algorithm
Narayan et al. [19]2003IndiaKeith EdwardsSens 91%, spec 88%Clinical diagnosis

Sant'Anna et al. [24]2006BrazilBrazil Ministry of HealthSens 89%, spec 86%Culture positive and respiratory symptoms and/or CXR improved using exclusively anti-TB drugs
Sant'Anna et al. [25]2004BrazilBrazil Ministry of Health82% very likely, 16% possible, 2.4% unlikelyClinical criteria and response to treatment
Pedrozo et al. [23]2009BrazilBrazil Ministry of HealthMedian score of TB positive groups higher than negativeClinical criteria

Fourie et al. [27]1998MultipleNewAnalyzed by age and country group: sens 30–73%, spec 10–75%, PPV 50–82%Positive radiologic or bacteriological data

Diagnostic classification

Migliori et al. [30]1992UgandaMiglioriGastric aspirate: sens 96.8%, spec 92.2%, PPV 68.2%, NPV 99.4%. Response to treatment: sens 62.5%, 94.1%, PPV 57.7%, NPV 95.1%Original Ghidey and Habte criteria
Salazar et al. [32]2001PeruMiglioriSens 92% (Migliori) versus 80% (Peru). 3/3 Peru criteria had 73% PPVMigliori criteria (without RTT)

Marais et al. [26]2006South AfricaNewChildren ≥3 and HIV uninfected: sens 82.3%, spec 90.2%, PPV 82.3%.
Children <3 and HIV uninfected: sens 51.8%, spec 92.5%, PPV 90.1%.
HIV infected: sens 56.2%, spec 61.8%, PPV 61.9%
Clinical criteria

Houwert et al. [38]1998South AfricaWHO provisional guidelines (1994)PPV of all 3 criteria when present simultaneously: 63%WHO diagnostic categories from 1994 used as the gold standard

Sens: sensitivity; spec: specificity; PTB: pulmonary tuberculosis; EPTB: extrapulmonary tuberculosis; PPV: positive predictive value; NPV: negative predictive value.