A Systematic Review of Clinical Diagnostic Systems Used in the Diagnosis of Tuberculosis in Children
A Systematic Review of Clinical Diagnostic Systems Used in the Diagnosis of Tuberculosis in Children
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DOI：
10.1155/2012/401896
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发表时间：
2012-01-01
影响因子：
1.7
通讯作者：
Ayaya, Samuel O.
中科院分区：
文献类型：
--
作者：
Pearce, Emily C.;Woodward, Jason F.;Ayaya, Samuel O.
背景由于缺乏金标准，特别是在资源有限的环境中，结核病很难在儿童中诊断。评分系统和诊断标准经常被用来协助诊断，但其有效性，特别是在艾滋病毒高流行地区的有效性，仍不清楚。方法.我们检索了在线书目数据库，包括MEDLINE和EMBASE。我们选择了所有涉及评分系统或诊断标准的研究，以帮助诊断儿童结核病，并从这些研究中提取数据。结果检索得到2261个标题，其中40个符合选择标准。18项研究使用基于积分的评分系统。18项研究使用了诊断标准。这些评分系统的验证产生了不同的敏感性，因为金标准的使用范围很广。四项研究评估并比较了多个评分标准。10项针对肺结核的研究。五项研究专门评估了艾滋病毒阳性儿童评分系统的使用情况，普遍发现特异性较低。结论.虽然评分系统和诊断标准仍然广泛用于儿童结核病的诊断，但由于缺乏一个既定的和可访问的金标准，验证一直很困难。对敏感性和特异性的估计差异很大，特别是在艾滋病毒合并感染率高的人群中。
Background. Tuberculosis (TB) is difficult to diagnose in children due to lack of a gold standard, especially in resource-limited settings. Scoring systems and diagnostic criteria are often used to assist in diagnosis; however their validity, especially in areas with high HIV prevalence, remains unclear. Methods. We searched online bibliographic databases, including MEDLINE and EMBASE. We selected all studies involving scoring systems or diagnostic criteria used to aid in the diagnosis of tuberculosis in children and extracted data from these studies. Results. The search yielded 2261 titles, of which 40 met selection criteria. Eighteen studies used point-based scoring systems. Eighteen studies used diagnostic criteria. Validation of these scoring systems yielded varying sensitivities as gold standards used ranged widely. Four studies evaluated and compared multiple scoring criteria. Ten studies selected for pulmonary tuberculosis. Five studies specifically evaluated the use of scoring systems in HIV-positive children, generally finding the specificity to be lower. Conclusions. Though scoring systems and diagnostic criteria remain widely used in the diagnosis of tuberculosis in children, validation has been difficult due to lack of an established and accessible gold standard. Estimates of sensitivity and specificity vary widely, especially in populations with high HIV co-infection.