Comparación de la capacidad predictiva de dos escalas para el diagnóstico de tuberculosis en niños / Comparison of the predictive ability of two scoring systems for the diagnosis of tuberculosis in children
Arch. argent. pediatr
; 113(6): 491-497, dic. 2015. graf, tab
Article
in English, Spanish
| LILACS, BINACIS
| ID: biblio-838135
Responsible library:
AR94.1
RESUMEN
El diagnóstico de tuberculosis en la infancia exige una fuerte presunción diagnóstica por su forma de presentación paucibacilar. Distintos sistemas de puntuación y algoritmos se han desarrollado para sortear esta dificultad. Entre ellos, la escala diagnóstica de Keith Edwards y la de Stegen modificada por Toledo (Stegen-Toledo). Objetivos. Comparar la capacidad predictiva de la escala diagnóstica de Keith Edwards con la de la escala de Stegen-Toledo. Estimar la capacidad predictiva diagnóstica de la radiografía de tórax en forma individual. Población, material y métodos. Pacientes atendidos en un Servicio de Neumonología Pediátrica de la Ciudad de Buenos Aires entre 2009 y 2012. Para el análisis de la capacidad predictiva diagnóstica, se utilizó el test de chi-cuadrado y, para comparar su desempeno, la prueba de Mc Nemar extendida. Resultados. Keith Edwards sensibilidad de 19,62%, especificidad de 97,62% (p < 0,0001). Stegen-Toledo sensibilidad de 43,54%, especificidad de 97,82% (p < 0,0001). La sensibilidad entre ambas escalas presentó una diferencia significativa (p < 0,05), sin diferencias en la especificidad. Radiografía de tórax sensibilidad de 91,15%, especificidad de 87,72% (p < 0,0001). Conclusión. La escala de Keith Edwards presentó una menor sensibilidad diagnóstica que la de Stegen-Toledo en este grupo de pacientes, sin diferencias en la especificidad. La radiografía de tórax presentó una sensibilidad de 91,15% para el diagnóstico de tuberculosis en este grupo de pacientes.
ABSTRACT
Diagnosing childhood tuberculosis requires a strong diagnostic suspicion due to its paucibacillary manifestation. Different scoring systems and algorithms have been developed to deal with such challenge skillfully. These include the Keith Edwards diagnostic score and Stegen's criteria modified by Toledo (Stegen-Toledo). Objectives. To compare the predictive ability of the Keith Edwards diagnostic score to that of the Stegen-Toledo scoring system. To estimate the predictive diagnostic ability of chest X-rays individually. Population, Material and Methods. Patients seen at the Department of Pediatric Pulmonology of the City of Buenos Aires between 2009 and 2012. A² test was used to analyze the predictive diagnostic ability, and performance was compared using the extended McNemar test. Results. Keith Edwards 19.62% sensitivity, 97.62% specificity (p < 0.0001). Stegen-Toledo 43.54% sensitivity, 97.82% specificity (p < 0.0001). Sensitivity was significantly different between both scoring systems (p < 0.05), but no differences were observed in terms of specificity. Chest X-ray 91.15% sensitivity, 87.72% specificity (p < 0.0001). Conclusion. The Keith Edwards scoring system showed a lower diagnostic sensitivity than the Stegen-Toledo score in this group of patients, with no differences observed in terms of specificity. The chest X-ray showed a 91.15% sensitivity to diagnose tuberculosis in this group of patients.
Full text:
Available
Collection:
International databases
Health context:
Neglected Diseases
Health problem:
Neglected Diseases
/
Tuberculosis
Database:
BINACIS
/
LILACS
Main subject:
Tuberculosis, Pulmonary
/
Predictive Value of Tests
/
Sensitivity and Specificity
/
Diagnostic Techniques, Respiratory System
Type of study:
Diagnostic study
/
Observational study
/
Prognostic study
/
Risk factors
Limits:
Child
/
Humans
Language:
English
/
Spanish
Journal:
Arch. argent. pediatr
Journal subject:
Pediatrics
Year:
2015
Document type:
Article
Affiliation country:
Argentina
Institution/Affiliation country:
Hospital General de Niños Pedro de Elizalde/AR