Evaluation of clinical parameters to predict Mycobacterium tuberculosis in inpatients. Academic Article uri icon

Overview

MeSH

  • Adult
  • Female
  • Humans
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Radiography

MeSH Major

  • Mycobacterium tuberculosis
  • Patient Isolation
  • Sputum
  • Tuberculosis

abstract

  • Respiratory isolation has been recommended for all patients with suspected tuberculosis (TB) to avoid transmission to other patients and health care personnel. In implementing these guidelines, patients with and without TB are frequently isolated, significantly increasing hospital costs. The objective of this study was to derive a clinical rule to predict the need for respiratory isolation of patients with suspected TB. To identify potential predictors of the need for isolation, 56 inpatients with sputum cultures positive for TB were retrospectively compared with 56 controls who were isolated on admission to the hospital based on clinically suspected TB but whose sputum cultures tested negative for TB. Variables analyzed included TB risk factors, clinical symptoms, and findings from physical examination and chest radiography. Multivariate analysis revealed that the following factors were significantly associated with a culture positive for TB: presence of TB risk factors or symptoms (odds ratio [OR], 7.9 [95% confidence interval (CI), 4.4-24.2]), a positive purified protein derivative tuberculin test result (OR, 13.2 [95% CI, 4.4-40.7]), high temperature (OR, 2.8 [95% CI, 1.1-8.3]), and upper-lobe disease on chest radiograph (OR, 14.6 [95% CI, 3.7-57.5]). Shortness of breath (OR, 0.2 [95% CI, 0.12-0.53]) and crackles noted during the physical examination (OR, 0.29 [95% CI, 0.15-0.57]) were negative predictors of TB. A scoring system was developed using these variables. A patient's total score of 1 or higher indicated the need for respiratory isolation, accurately predicting a culture positive for TB (98% sensitivity [95% CI, 95%-100%]; 46% specificity [95% CI, 33%-59%]). Among inpatients with suspected active pulmonary TB, a prediction rule based on clinical and chest radiographic findings accurately identified patients requiring respiratory isolation.

publication date

  • September 11, 2000

has subject area

  • Adult
  • Female
  • Humans
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Mycobacterium tuberculosis
  • Patient Isolation
  • Radiography
  • Sputum
  • Tuberculosis

Research

keywords

  • Journal Article

Identity

Language

  • eng

PubMed ID

  • 10979058

Additional Document Info

start page

  • 2471

end page

  • 2476

volume

  • 160

number

  • 16