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Diagnostic Accuracy of Clinical Diagnostic Scoring Systems for Childhood Tuberculosis: A Systematic Review and

Michael Kakinda1, Ronald Olum2,3, Joseph Baruch Baluku3,4,5

  • 1Clinical Directorate, Joint Clinical Research Center, Kampala, Uganda.

Open Forum Infectious Diseases
|January 15, 2024
PubMed

Insights

Diagnosing childhood tuberculosis (TB) is challenging. A systematic review recommends the Keith Edwards scoring system for its high accuracy in diagnosing pediatric TB, but further research is needed for children with HIV and malnutrition.

Area of Science:

  • Pediatric infectious diseases
  • Diagnostic accuracy studies
  • Tuberculosis diagnostics

Background:

  • Childhood tuberculosis (TB) diagnosis presents significant challenges.
  • Point-based scoring systems and diagnostic algorithms aim to improve diagnostic yield in pediatric TB.
  • An updated systematic review of existing childhood TB scoring systems and algorithms is lacking.

Purpose of the Study:

  • To systematically review the diagnostic accuracy of scoring systems and algorithms for childhood TB.
  • To identify the most effective diagnostic tools for pediatric tuberculosis.

Main Methods:

  • Systematic search of PubMed, CINAHL, Embase, Scopus, and Google Scholar databases (up to March 30, 2023).
  • Quality assessment of studies using QUADAS-2.
  • Pooled analysis of diagnostic accuracy measures (sensitivity, specificity, diagnostic odds ratio, likelihood ratios) using a random-effects model.

Main Results:

  • Fifteen studies involving 7327 participants (<15 years) were included, evaluating 10 diagnostic tools.
  • The Keith Edwards scoring system showed high diagnostic accuracy (sensitivity 81.9%, specificity 81.2%) across 5 studies.
  • Other evaluated tools included Kenneth Jones criteria (sensitivity 80.1%, specificity 45.7%) and Ministry of Health-Brazil algorithm (sensitivity 79.9%, specificity 73.2%).

Conclusions:

  • The Keith Edwards scoring system is recommended due to its superior sensitivity and specificity for diagnosing childhood TB.
  • Further research is required to evaluate the effectiveness of these tools in children with co-existing HIV and malnutrition.
Abstract

Keywords:
diagnostic scoring systemdiagnostic test accuracypediatric TB

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