Avaliação de um escore clínico para rastreamento de suspeitos de tuberculose pulmonar

Abstract

OBJECTIVE:To assess the accuracy (sensitivity) of a clinical score for presumptive pulmonary tuberculosis cases during screening. METHODS:Descriptive cross-sectional study comprising 1,365 patients attending the department of lung diseases at a secondary care outpatient clinic in the city of Rio de Janeiro, Southeastern Brazil, during 2006 and 2007. All respondents answered a standardized questionnaire administered by the clinic's nursing staff. Information on age, weight and clinical symptoms were collected. The presumptive diagnosis of pulmonary tuberculosis was made by summing up the scores of the data collected. The diagnosis of active tuberculosis was based on bacteriological fi ndings and medical criteria. There were estimated sensitivity, specifi city, positive predictive value and negative predictive value for a set prevalence, and 95% confi dence intervals for different score cutoffs. The score performance was assessed using the receiver operating characteristic (ROC) curve. RESULTS:For the diagnosis of tuberculosis, cough for more than one week and cough for more than three weeks showed a sensitivity of 88.2% (86.2, 90.2) and 61.1% (57.93, 64.3), specifi city 19.2% (16.6, 21.8) and 51.3% (48.1, 54.5), respectively. The clinical score of 8 had a sensitivity of 83.13% (77.8, 87.6), specifi city of 51.8% (48.5, 55.1), positive predictive value of 91.6% (90.0, 83.2) and negative predictive value of 32.9% (30.1, 35.7). CONCLUSIONS:Cough for more than three weeks showed low sensitivity and specifi city. A highly sensitive clinical score can be an alternative tool for screening pulmonary tuberculosis as it allows early care of suspected cases and standard nursing care approach.

Prevalence and risk factors for latent tuberculosis infection among healthcare workers in Nampula Central Hospital, Mozambique

“…Initially all volunteering HCWs were administered a TB symptom screening questionnaire [23] with symptomless HCWs being administered a second questionnaire collecting information on individual, occupational and administrative risk factors. This questionnaire of closed ended questions was designed using the TB risk assessment worksheet from United States Centers for Disease Control and Prevention (CDC) [24], validated and corrected in a pilot study.…”

Tuberculose pulmonar entre usuários de uma unidade de atenção básica

“…Inicialmente, os indivíduos incluídos no estudo responderam a um escore clínico de alta sensibilidade para o diagnóstico presuntivo de TB (9) . Este instrumento é composto por questões de fácil resposta, sem causar constrangimento na entrevista de triagem; sua pontuação varia de zero a 22, o que gera um sistema de escore para a aplicação em pacientes com suspeita de TB.…”

Nursing Approach to the Control of Tuberculosis: Scientific Publications (2002-2011)

“…Studies selected for analysis in this study showed that nursing staff need to have innovative and efficient tools for patients and their families for early diagnosis (Castro et al, 2011;Silva at al., 2011), as well as effective strategies for monitoring TB treatment (Maciel et al, 2010;Rodrigues et al, 2008).…”