title: A clinical prediction rule for pulmonary tuberculosis in emergency departments.
abstract: METHODS
  University-affiliated hospital located in an area with a high incidence of pulmonary tuberculosis (PTB).
  
  
  OBJECTIVE
  To develop a clinical prediction rule (CPR) based on information obtainable on admission, to permit rapid identification of patients with PTB.
  
  
  METHODS
  Information from patients with respiratory symptoms who attended the emergency department of Cayetano Heredia Hospital, Lima, Peru, was collected prospectively. Clinical symptoms, past medical history, demographic data and results of chest X-rays (CXRs), sputum smear and culture in Löwenstein-Jensen media were obtained. Based on logistic regression, we constructed a scoring system to predict PTB.
  
  
  RESULTS
  A total of 345 patients were enrolled in the study, including 109 (31%) culture-proven PTB cases. In logistic regression analysis, we found age, previous history of PTB, weight loss, presence of cavities, upper lobe infiltrate and miliary pattern on CXR as independent predictors of PTB. We designed a scoring system with these variables, taking into account their statistical weight. The score attained 93% sensitivity and 42% specificity.
  
  
  CONCLUSIONS
  The CPR that was developed performed well in our population. It merits further validation in other settings. It should not, however, replace, but should complement sputum microscopy when deciding on isolation, and it does not preclude microbiology in making a definitive diagnosis.
authors.affiliation: Hospital Nacional Hipólito Unanue, Lima, Peru.
authors.forename: L
authors.initials: L
authors.lastname: Solari
authors.forename: C
authors.initials: C
authors.lastname: Acuna-Villaorduna
authors.forename: A
authors.initials: A
authors.lastname: Soto
authors.forename: J
authors.initials: J
authors.lastname: Agapito
authors.forename: F
authors.initials: F
authors.lastname: Perez
authors.forename: F
authors.initials: F
authors.lastname: Samalvides
authors.forename: J
authors.initials: J
authors.lastname: Zegarra
authors.forename: J
authors.initials: J
authors.lastname: Diaz
authors.forename: E
authors.initials: E
authors.lastname: Gotuzzo
authors.forename: P
authors.initials: P
authors.lastname: Van der Stuyft
mesh_terms: D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D010568:Peru; D011446:Prospective Studies; D012372:ROC Curve; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*