Research Article

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

Table 5

Studies focusing primarily on pulmonary tuberculosis.

AuthorYearCountryScoring systemPercent also with EPTBValidation

Shah et al. [12]1992IndiaModified Kenneth JonesLooked at “primary complex” (just pulmonary) versus “progressive primary complex” (pulmonary plus LAD)Not analyzed, just used in inclusion criteria

Migliori et al. [30]1992UgandaMiglioriAll pulmonaryGastric 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%

Beyers et al. [35]1994South AfricaModified 1883 WHO criteriaAll pulmonary—excluded extrapulmonary tuberculosis without lung involvementNot evaluated

Salazar et al. [32]2001PeruMiglioriAll pts had PTB, 21/135 had EPTB as well: lymphadenopathy, intestinal-intraperitoneal TB, intra-abdominal lymphadenopathy, miliary disease, meningitis, and optic involvement. 3 with EPTB did not meet criteria for PTBSens 92% (Migliori) versus 80% (Peru). 3/3 Peru criteria had 73% PPV

Sant'Anna et al. [25]2004BrazilBrazil Ministry of Health82% very likely, 16% possible, 2.4% unlikelyAll pulmonary plus 5 pts with assoc extrapulmonary TB

Sant'Anna et al. [24]2006BrazilBrazil Ministry of HealthCut off ≥40: sens 58% and spec 98% but missed 42% of confirmed PTB.
Cut off ≥30: sens 89% and spec 86%
Pulmonary

Oberhelmen et al. [14]2006PeruStegen-ToledoNot analyzed, just used in inclusion criteriaPulmonary

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%
Focused on pulmonary TB only

Viani et al. [8]2008MexicoStegen-ToledoLooked retrospectively: 10/13 highly probable, 2/13 probable, 1/13 suspicious100% pulmonary, 54% also had disseminated

Pedrozo et al. [23]2009BrazilBrazil Ministry of HealthAnalyzed scoring system by looking at median scores of various groups: median score of 3a and 3b sig. higher than 1 and 2, median score also was higher than the cut off of 30Pulmonary only

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