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Validation of the Online Collaborative Ocular Tuberculosis Study Calculator for Tubercular Uveitis
Ludi Zhang1, William Rojas-Carabali1,2, Shannon Sheriel Choo2
1Lee Kong Chian School of Medicine, Nanyang Technological University of Singapore.
JAMA Ophthalmology
|October 31, 2024
Summary
The Collaborative Ocular Tuberculosis Study (COTS) calculator demonstrates higher specificity than clinician judgment for initiating antitubercular therapy (ATT) in suspected tubercular uveitis (TBU). This tool aids in more selective ATT recommendations, especially in high-prevalence settings.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Diagnostic Accuracy Studies
Background:
- Tubercular uveitis (TBU) diagnosis can be challenging, often relying on clinical judgment.
- The Collaborative Ocular Tuberculosis Study (COTS) calculator was developed to aid in treatment decisions.
Purpose of the Study:
- To statistically evaluate the predictive accuracy of the COTS calculator in guiding antitubercular therapy (ATT) initiation for clinically suspicious TBU.
- To compare the accuracy of the COTS calculator against clinician judgment.
Main Methods:
- Retrospective analysis of the COTS-1 study dataset (2004-2014) from international ophthalmic centers.
- Used 12-month treatment response to ATT as a surrogate for disease status.
- Calculated diagnostic accuracy metrics (sensitivity, specificity, PPV) for COTS calculator scores (≥4 and 5) versus clinician decisions.
Main Results:
- The COTS calculator (score ≥4) showed higher specificity (64.3%) compared to clinician judgment (29.6%).
- Clinician judgment had higher sensitivity (95.5%) than COTS-5 (26%).
- COTS-5 demonstrated the highest specificity (88.7%). Positive predictive value and sensitivity were higher in endemic regions.
Conclusions:
- The COTS calculator (score ≥4) is more specific than clinician judgment for initiating ATT in TBU.
- COTS-5 may reduce false positives when used after initial clinical assessment.
- The calculator is particularly useful in high-prevalence, low-resource settings for selective ATT recommendations.
