Background: Diagnosing tuberculosis in children remains a challenge especially in low-income countries. The aim of this study was to assess the performance of the scoring system combined to chest x-ray images compared to GeneXpert for diagnosis of pediatric tuberculosis.Methods: A retrospective diagnostic accuracy study was carried out on hospitalized children aged 0 to 14 years old, tuberculosis suspect in the pediatric department of the Tsaralalana mother child university hospital center from August 2018 to June 2020.Results: Fifty-one medical files were retained. The mean age was 4±2 years old with a sex ratio of 1.55. The reason for consultation was dominated by respiratory signs (56.9%). The GeneXpert was positive in 58.9% of cases. The chest X-ray images were pathological in all cases, dominated by images of condensation or infiltration (72.5%). WHO score was positive (≥7) in 72.5% of cases. The clinico-radiological criteria had a sensitivity of 13.3-63.3%, a specificity of 61.9-95.2%, positive predictive values of 1.5-6.9% and negative predictive values of 98.8-99.3%.Conclusion: Clinico-radiological criteria could be useful in individual diagnosis of pediatric tuberculosis.