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

Background. Tuberculosis (TB) is difficult to diagnose in children due to lack of a gold standard, especially in resource-limited settings. Scoring systems and diagnostic criteria are often used to assist in diagnosis; however their validity, especially in areas with high HIV prevalence, remains un...

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Main Authors: Emily C. Pearce, Jason F. Woodward, Winstone M. Nyandiko, Rachel C. Vreeman, Samuel O. Ayaya
Format: Article
Language:English
Published: Wiley 2012-01-01
Series:AIDS Research and Treatment
Online Access:http://dx.doi.org/10.1155/2012/401896
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author Emily C. Pearce
Jason F. Woodward
Winstone M. Nyandiko
Rachel C. Vreeman
Samuel O. Ayaya
author_facet Emily C. Pearce
Jason F. Woodward
Winstone M. Nyandiko
Rachel C. Vreeman
Samuel O. Ayaya
author_sort Emily C. Pearce
collection DOAJ
description Background. Tuberculosis (TB) is difficult to diagnose in children due to lack of a gold standard, especially in resource-limited settings. Scoring systems and diagnostic criteria are often used to assist in diagnosis; however their validity, especially in areas with high HIV prevalence, remains unclear. Methods. We searched online bibliographic databases, including MEDLINE and EMBASE. We selected all studies involving scoring systems or diagnostic criteria used to aid in the diagnosis of tuberculosis in children and extracted data from these studies. Results. The search yielded 2261 titles, of which 40 met selection criteria. Eighteen studies used point-based scoring systems. Eighteen studies used diagnostic criteria. Validation of these scoring systems yielded varying sensitivities as gold standards used ranged widely. Four studies evaluated and compared multiple scoring criteria. Ten studies selected for pulmonary tuberculosis. Five studies specifically evaluated the use of scoring systems in HIV-positive children, generally finding the specificity to be lower. Conclusions. Though scoring systems and diagnostic criteria remain widely used in the diagnosis of tuberculosis in children, validation has been difficult due to lack of an established and accessible gold standard. Estimates of sensitivity and specificity vary widely, especially in populations with high HIV co-infection.
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spelling doaj-art-42c1bbfceff74682a69c054416dcdff72025-08-20T02:39:18ZengWileyAIDS Research and Treatment2090-12402090-12592012-01-01201210.1155/2012/401896401896A Systematic Review of Clinical Diagnostic Systems Used in the Diagnosis of Tuberculosis in ChildrenEmily C. Pearce0Jason F. Woodward1Winstone M. Nyandiko2Rachel C. Vreeman3Samuel O. Ayaya4Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USADepartment of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USADepartment of Pediatrics, Moi University School of Medicine, Eldoret 30100, KenyaDepartment of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USADepartment of Pediatrics, Moi University School of Medicine, Eldoret 30100, KenyaBackground. Tuberculosis (TB) is difficult to diagnose in children due to lack of a gold standard, especially in resource-limited settings. Scoring systems and diagnostic criteria are often used to assist in diagnosis; however their validity, especially in areas with high HIV prevalence, remains unclear. Methods. We searched online bibliographic databases, including MEDLINE and EMBASE. We selected all studies involving scoring systems or diagnostic criteria used to aid in the diagnosis of tuberculosis in children and extracted data from these studies. Results. The search yielded 2261 titles, of which 40 met selection criteria. Eighteen studies used point-based scoring systems. Eighteen studies used diagnostic criteria. Validation of these scoring systems yielded varying sensitivities as gold standards used ranged widely. Four studies evaluated and compared multiple scoring criteria. Ten studies selected for pulmonary tuberculosis. Five studies specifically evaluated the use of scoring systems in HIV-positive children, generally finding the specificity to be lower. Conclusions. Though scoring systems and diagnostic criteria remain widely used in the diagnosis of tuberculosis in children, validation has been difficult due to lack of an established and accessible gold standard. Estimates of sensitivity and specificity vary widely, especially in populations with high HIV co-infection.http://dx.doi.org/10.1155/2012/401896
spellingShingle Emily C. Pearce
Jason F. Woodward
Winstone M. Nyandiko
Rachel C. Vreeman
Samuel O. Ayaya
A Systematic Review of Clinical Diagnostic Systems Used in the Diagnosis of Tuberculosis in Children
AIDS Research and Treatment
title A Systematic Review of Clinical Diagnostic Systems Used in the Diagnosis of Tuberculosis in Children
title_full A Systematic Review of Clinical Diagnostic Systems Used in the Diagnosis of Tuberculosis in Children
title_fullStr A Systematic Review of Clinical Diagnostic Systems Used in the Diagnosis of Tuberculosis in Children
title_full_unstemmed A Systematic Review of Clinical Diagnostic Systems Used in the Diagnosis of Tuberculosis in Children
title_short A Systematic Review of Clinical Diagnostic Systems Used in the Diagnosis of Tuberculosis in Children
title_sort systematic review of clinical diagnostic systems used in the diagnosis of tuberculosis in children
url http://dx.doi.org/10.1155/2012/401896
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