Derivation and Validation of a Clinical Prediction Score for Isolation of Inpatients With Suspected Pulmonary Tuberculosis

The use of a clinical prediction score to improve the practice of instituting airborne-transmission precautions in patients with suspected tuberculosis holds promise for increasing appropriate isolation and decreasing unnecessary isolation. The objective of this study was to derive and validate a cl...

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Bibliographic Details
Published in:	Infection control and hospital epidemiology Vol. 29; no. 10; pp. 927 - 932
Main Authors:	Rakoczy, Kara S., Cohen, Stuart H., Nguyen, Hien H.
Format:	Journal Article
Language:	English
Published:	Thorofare, NJ The University of Chicago Press 01-10-2008 Slack
Subjects:	Alcoholism Bacterial diseases Bacterial diseases of the respiratory system Biological and medical sciences Case-Control Studies Cross Infection - drug therapy Cross Infection - microbiology Cross Infection - prevention & control Cross Infection - transmission Female HIV Hospital admissions Human bacterial diseases Human immunodeficiency virus Humans Infection Control - methods Infections Infectious diseases Inpatients Male Medical practice Medical sciences Middle Aged Miscellaneous Models, Biological Mycobacterium Mycobacterium tuberculosis Mycobacterium tuberculosis - isolation & purification Nursing Original Article Patient Isolation Predictive Value of Tests Public health. Hygiene Public health. Hygiene-occupational medicine Pulmonary tuberculosis Risk Assessment Sensitivity and Specificity Symptoms Tuberculin Tuberculosis Tuberculosis and atypical mycobacterial infections Tuberculosis, Pulmonary - drug therapy Tuberculosis, Pulmonary - microbiology Tuberculosis, Pulmonary - prevention & control Tuberculosis, Pulmonary - transmission Infection Lung disease Respiratory disease Pulmonary tuberculosis Bacteriosis Isolation Mycobacterial infection Predictive factor Public health
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Summary:	The use of a clinical prediction score to improve the practice of instituting airborne-transmission precautions in patients with suspected tuberculosis holds promise for increasing appropriate isolation and decreasing unnecessary isolation. The objective of this study was to derive and validate a clinical prediction score for patients with suspected tuberculosis. We used a case-control study design to evaluate differences between patients with a diagnosis of tuberculosis and those placed under airborne precautions who had negative culture results. We developed risk scores based on a multivariable analysis of independently significant factors associated with tuberculosis. Subsequently, we evaluated the sensitivity and specificity of the score in a separate (validation) cohort of patients. Within our population, we found 4 clinical factors associated with tuberculosis: chronic symptoms (odds ratio [OR], 10.2 [95% confidence interval {CI}, 2.95-35.4]), upper lobe disease on chest radiograph (OR, 5.27 [95% CI, 1.6-17.23]), foreign-born status (OR, 7.01 [95% CI, 2.1-23.8]), and immunocompromised state other than human immunodeficiency virus infection (OR, 8.14 [95% CI, 2.08-31.8]). Shortness of breath (OR, 0.13 [95% CI, 0.04-0.45]) was found to be associated with non-tuberculosis diagnoses and considered a negative predictor in the model. Using a cut-off point to maximize sensitivity, we applied the prediction rule to the validation cohort, resulting in a sensitivity of 97% and a specificity of 42%. The tuberculosis prediction rule derived from our patient population could improve utilization of airborne precautions. Clinical prediction rules continue to show their utility for improvement in isolation practices in different demographic areas.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0899-823X 1559-6834
DOI:	10.1086/590667