A simple, valid, numerical score for grading chest x-ray severity in adult smear-positive pulmonary tuberculosis

Abstract

BackgroundThe grading of radiological severity in clinical trials in tuberculosis (TB) remains unstandardised. The aim of this study was to generate and validate a numerical score for grading chest x-ray (CXR) severity and predicting response to treatment in adults with smear-positive pulmonary TB. Methods At a TB clinic in Papua, Indonesia, serial CXRs were performed at diagnosis, 2 and 6 months in 115 adults with smear-positive pulmonary TB. Radiographic findings predictive of 2-month sputum microscopy status were used to generate a score. The validity of the score was then assessed in a second data set of 139 comparable adults with TB, recruited 4 years later at the same site. Relationships between the CXR score and other measures of TB severity were examined. Results The estimated proportion of lung affected and presence of cavitation, but not cavity size or other radiological findings, significantly predicted outcome and were combined to derive a score given by percentage of lung affected plus 40 if cavitation was present. As well as predicting 2-month outcome, scores were significantly associated with sputum smear grade at diagnosis (p<0.001), body mass index, lung function, haemoglobin, exercise tolerance and quality of life (p<0.02 for each). In the validation data set, baseline CXR score predicted 2-month smear status significantly more accurately than did the proportion of lung affected alone. In both data sets, CXR scores decreased over time (p<0.001). Conclusion This simple, validated method for grading CXR severity in adults with smear-positive pulmonary TB correlates with baseline clinical and microbiological severity and response to treatment, and is suitable for use in clinical trials.

Antimycobacterial Drugs Modulate Immunopathogenic Matrix Metalloproteinases in a Cellular Model of Pulmonary Tuberculosis

“…Heavily blood-stained samples were excluded from the study. A chest X-ray (CXR) scoring system was devised, derived from published scoring systems (31)(32)(33)(34)(35). Zero to three points were scored reflecting the absence of cavities, presence of cavities of Ͻ2 cm, cavities of 2 to 4 cm, and cavities of Ͼ4 cm in size respectively.…”

Scoring systems using chest radiographic features for the diagnosis of pulmonary tuberculosis in adults: a systematic review

“…Five studies that involved the grading of chest radiographs were excluded, as these studies were designed to grade the severity of PTB based on the extent of abnormalities visualised on the chest radiograph and not the diagnostic accuracy of scoring systems [55][56][57][58][59]. We also excluded three studies that used the Chest Radiograph Reading and Recording System (CRRS) [60][61][62], despite these studies demonstrating the CRRS tool to have good reliability for features of PTB visualised on a chest radiograph, as these studies did not use culture as a reference standard.…”

Inter-Observer Variability in the Detection and Interpretation of Chest X-Ray Anomalies in Adults in an Endemic Tuberculosis Area

“…Dawson et al [27] founded similar results (K = 0.32) between radiologists in South Africa. Anna Ralph et al [28] observed low concordance (K = 0.12) between radiologists in Australia. In our study, observers were generally more consistent for the detection of nodules than for the detection of caverns even if individual performances were better in the detection of caverns.…”