Derivation of a tuberculosis screening rule for sub-Saharan African prisons
Derivation of a tuberculosis screening rule for sub-Saharan African prisons
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DOI：
10.5588/ijtld.13.0732
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发表时间：
2014-07-01
影响因子：
4
通讯作者：
Reid, S. E.
中科院分区：
文献类型：
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作者：
Harris, J. B.;Siyambango, M.;Reid, S. E.
环境：卢萨卡中央监狱，赞比亚。目的：获得结核病（TB）的筛选规则，使用在监狱范围内的结核病和人类免疫缺陷病毒（HIV）筛选program.DESIGN收集的数据：我们得出的规则与两种方法：逻辑回归和分类和回归树（C&RT）。我们通过敏感性、特异性、阳性预测值和阴性预测值评估了衍生规则以及现有世界卫生组织（WHO）筛查建议在我们的囚犯队列中的表现。结果：C& RT衍生规则建议对所有体重不足的囚犯进行诊断测试（定义为体重指数[BMI] < 18.5 kg/m（2）]或感染艾滋病毒; C& RT推导的规则具有60%的敏感性和71%的特异性。逻辑回归衍生规则建议对体重不足、艾滋病毒感染或胸痛的囚犯进行诊断测试;逻辑回归衍生规则的敏感性为74%，特异性为57%。两个世界卫生组织的建议有敏感性，类似于我们的逻辑回归规则，但有较差的特异性，导致更大的测试burner.CONCLUSION：低BMI和HIV感染是最强大的预测结核病在我们的囚犯，胸痛另外保留在一个模型。应进一步评估BMI和艾滋病毒，作为囚犯结核病筛查规则的基础，并根据需要进行修改，以改善规则的执行情况。
SETTING: Lusaka Central Prison, Zambia.OBJECTIVE: To derive screening rules for tuberculosis (TB) using data collected during a prison-wide TB and human immunodeficiency virus (HIV) screening program.DESIGN: We derived rules with two methodologies: logistic regression and classification and regression trees (C&RT). We evaluated the performance of the derived rules as well as existing World Health Organization (WHO) screening recommendations in our cohort of inmates, as measured by sensitivity, specificity, and positive and negative predictive values.RESULTS: The C&RT-derived rule recommended diagnostic testing of all inmates who were underweight (defined as body mass index [BMI] < 18.5 kg/m(2)] or HIV-infected; the C&RT-derived rule had 60% sensitivity and 71% specificity. The logistic regression-derived rule recommended diagnostic testing of inmates who were underweight, HIV-infected or had chest pain; the logistic regression-derived rule had 74% sensitivity and 57% specificity. Two of the WHO recommendations had sensitivities that were similar to our logistic regression rule but had poorer specificities, resulting in a greater testing burden.CONCLUSION: Low BMI and HIV infection were the most robust predictors of TB in our inmates; chest pain was additionally retained in one model. BMI and HIV should be further evaluated as the basis for TB screening rules for inmates, with modification as needed to improve the performance of the rules.