The Collaborative Ocular Tuberculosis Study (COTS) calculator-a consensus-based decision tool for initiating...

Area of Science:

• Ophthalmology
• Infectious Diseases
• Public Health

Background:

• Ocular tuberculosis (TB) requires timely initiation of antitubercular therapy (ATT) for effective management.
• Clinical decision-making for ATT in ocular TB can be complex, influenced by various clinical and diagnostic factors.

Purpose of the Study:

• To introduce the Collaborative Ocular Tuberculosis Study (COTS) Calculator, an online clinical scoring system.
• To provide a standardized tool for initiating antitubercular therapy (ATT) in patients with ocular tuberculosis (TB).

Main Methods:

• The COTS Calculator was developed using a two-step Delphi method with 81 experts evaluating 486 clinical scenarios.
• Expert consensus on initiating ATT was determined based on clinical phenotype, endemicity, immunological tests (TST, IGRA), and radiological findings (Chest X-Ray).
• Consensus scores were encoded to create the online COTS Calculator accessible at https://www.oculartb.net/cots-calc.

Main Results:

• The COTS Calculator generates a median score from 1 to 5 based on patient-specific conditions.
• A median score of 5, indicating expert consensus to initiate ATT, was observed in 114 out of 486 (24%) evaluated scenarios.
• The tool provides a quantitative measure to support clinical judgment in ATT initiation.

Conclusions:

• The COTS Calculator is an efficient, low-cost, evidence-based clinical tool for guiding ATT initiation in ocular TB.
• It has the potential to improve the standard-of-care for patients with ocular tuberculosis.
• Further validation studies are recommended to ascertain the clinical utility and reliability of the COTS Calculator.