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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Diagnostic accuracy of an integrated respiratory guideline in identifying patients with respiratory symptoms requiring screening for pulmonary tuberculosis: A cross-sectional study
BMC Pulmonary Medicine, Volume 6, Article 22, Year 2006
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Description
Background: To evaluate the diagnostic accuracy of the integrated Practical Approach to Lung Health in South Africa (PALSA) guideline in identifying patients requiring bacteriological screening for tuberculosis (TB), and to determine which clinical features best predict suspected and bacteriologically-confirmed tuberculosis among patients with respiratory symptoms. Methods: A prospective, cross-sectional study in which 1392 adult patients with cough and/or difficult breathing, attending a primary care facility in Cape Town, South Africa, were evaluated by a nurse using the guideline. The accuracy of a nurse using the guideline to identify TB suspects was compared to that of primary care physicians' diagnoses of (1) suspected TB, and (2) proven TB supported by clinical information and chest radiographs. Results: The nurse using the guideline identified 516 patients as TB suspects compared with 365 by the primary care physicians, representing a sensitivity of 76% (95% confidence interval (CI) 71%-79%), specificity of 77% (95% CI 74%-79%), positive predictive value of 53% (95% CI 49%-58%), negative predictive value of 90% (95% CI 88%-92%), and area under the receiver operating characteristic curve (ARUC) of 0.76 (95% CI 0.74-0.79). Sputum results were obtained in 320 of the 365 primary care physicians TB suspects (88%); 40 (13%) of these were positive for TB. Only 4 cases were not identified by the nurse using the guideline. The primary care physicians diagnostic accuracy in diagnosing bacteriologically-confirmed TB (n = 320) was as follows: sensitivity 90% (95% CI 76%-97%), specificity 65% (95% CI 63%-68%), negative predictive value 7% (95% CI 5%-10%), positive predictive value 99.5% (95% CI 98.8%-99.8%), and ARUC 0.78 (95% CI 0.73-0.82). Weight loss, pleuritic pain, and night sweats were independently associated with the diagnosis of bacteriologically-confirmed tuberculosis (positive likelihood ratio if all three present = 16.7, 95% CI 5.9-29.4). Conclusion: The PALSA guideline is an effective screening tool for identifying patients requiring bacteriological screening for pulmonary tuberculosis in this primary care setting. This supports the randomized trial finding that use of the guideline increased TB case detection. © 2006 English et al; licensee BioMed Central Ltd.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC1569870/bin/1471-2466-6-22-S1.pdf
Authors & Co-Authors
English, René Glynnis
South Africa, Cape Town
University of Cape Town Lung Institute
Bachmann, Max Oscar
United Kingdom, Norwich
University of East Anglia
Bateman, E. D.
South Africa, Cape Town
University of Cape Town Lung Institute
Zwarenstein, Merrick F.
Canada, Toronto
University of Toronto
Fairall, Lara R.
South Africa, Cape Town
University of Cape Town Lung Institute
Bheekie, Angeni
South Africa, Bellville
University of the Western Cape
Majara, Bosielo P.
South Africa, Bloemfontein
University of the Free State
Lombard, Carl J.
South Africa, Tygerberg
South African Medical Research Council
Scherpbier, Robert W.
Switzerland, Geneva
Organisation Mondiale de la Santé
Ottmani, Salah Eddine
Switzerland, Geneva
Organisation Mondiale de la Santé
Statistics
Citations: 45
Authors: 10
Affiliations: 7
Identifiers
Doi:
10.1186/1471-2466-6-22
ISSN:
14712466
e-ISSN:
14712466
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Approach
Quantitative
Study Locations
South Africa