Score of Solari et al for Diagnosis of Pulmonary Tuberculosis in the Emergency Department

Description

Solari et al report a simple score for detection of pulmonary tuberculosis in an Emergency Department. This can result in earlier detection and isolation of affected patients. The authors are from Hospital Nacional Hipolito Unanue (Lima), Washington Hospital Center, Universidad Peruana Cayetano Heredia and the Institute of Tropical Medicine (Antwerp).

Patient selection: adult in the emergency department of a hospital in a region with high prevalence of tuberculosis

Parameters:

(1) age in years

(2) weight loss

(3) history of pulmonary tuberculosis

(4) miliary pattern on chest X-ray

(5) cavitary disease on chest X-ray

(6) upper lobe infiltrate on chest X-ray

Parameter	Finding	Points
age in years	< 35 years	0
	35 to 60 years	-1
	>= 61 years	-2
weight loss	no	0
	yes	5
history of pulmonary TB	no	0
	yes	-3
miliary pattern	no	0
	yes	10
cavitary disease	no	0
	yes	5
upper lobe infiltrate	no	0
	yes	9

total score =

= SUM(points for all 6 parameters)

Interpretation:

• minimum score: -5

• maximum score: 29

• A score >= 3 is considered positive with a sensitivity of 93% and specificity of 42%.

• A score >= 2 has a sensitivity of 95% and specificity of 36%.

• Sputum culture for AFB is recommended to detect false negatives.

Performance:

• The area under the ROC curve was 0.81.

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Score of Solari et al for Diagnosis of Pulmonary Tuberculosis in the Emergency Department

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