Development and Validation of the TELL Score (Pleural Thickening (T), Fluid Echogenicity (E), Loculations (L), and...

Pleural effusion classification guides management, but Light's criteria require invasive sampling and laboratory infrastructure and may be prone to misclassifications. A rapid, bedside alternative is needed, particularly in resource-limited settings.  Aim: This study aimed to develop and validate a novel, four-point sonographic scoring system, the TELL (pleural thickening (T), fluid echogenicity (E), loculations (L), and laterality (L)) score, for differentiating pleural effusions at the bedside.

This is a prospective observational study conducted at Saveetha Medical College Hospital, a tertiary care centre in South India from March 2021 to February 2022. Seventy-four adult patients with pleural effusions underwent thoracic ultrasonography, assessing four "TELL" parameters: pleural thickening (≥3 mm), fluid echogenicity, laterality (unilateral effusions), and presence of loculations. Each positive finding scored one point (range 0-4). Diagnostic performance was compared against Light's criteria using diagnostic indices and receiver operator characteristic (ROC) curve analysis.

Among 74 participants (mean age 58.7±17.2 years; 59.5% male), 64 effusions (86.5%) were exudates, mainly tuberculosis and malignancy. Sonographic features were more common in exudates: pleural thickening (95.3%), echogenicity (98.4%), loculations (29.7%), and unilateral distribution (85.9%; all p < 0.01). At cut-off ≥2, the TELL score achieved 98.4% sensitivity, 40% specificity, negative predictive value (NPV) 80%, and area under the curve (AUC) 0.79 (95% confidence interval CI: 0.64-0.94) Conclusions: The TELL score is a rapid, non-invasive screening tool with high sensitivity and NPV, particularly useful when lab confirmation is delayed or unavailable. Multicentre validation and reliability studies in larger cohorts are needed.