title: A simple, valid, numerical score for grading chest x-ray severity in adult smear-positive pulmonary tuberculosis.
abstract: BACKGROUND
  The grading of radiological severity in clinical trials in tuberculosis (TB) remains unstandardised. The aim of this study was to generate and validate a numerical score for grading chest x-ray (CXR) severity and predicting response to treatment in adults with smear-positive pulmonary TB.
  
  
  METHODS
  At a TB clinic in Papua, Indonesia, serial CXRs were performed at diagnosis, 2 and 6 months in 115 adults with smear-positive pulmonary TB. Radiographic findings predictive of 2-month sputum microscopy status were used to generate a score. The validity of the score was then assessed in a second data set of 139 comparable adults with TB, recruited 4 years later at the same site. Relationships between the CXR score and other measures of TB severity were examined.
  
  
  RESULTS
  The estimated proportion of lung affected and presence of cavitation, but not cavity size or other radiological findings, significantly predicted outcome and were combined to derive a score given by percentage of lung affected plus 40 if cavitation was present. As well as predicting 2-month outcome, scores were significantly associated with sputum smear grade at diagnosis (p<0.001), body mass index, lung function, haemoglobin, exercise tolerance and quality of life (p<0.02 for each). In the validation data set, baseline CXR score predicted 2-month smear status significantly more accurately than did the proportion of lung affected alone. In both data sets, CXR scores decreased over time (p<0.001).
  
  
  CONCLUSIONS
  This simple, validated method for grading CXR severity in adults with smear-positive pulmonary TB correlates with baseline clinical and microbiological severity and response to treatment, and is suitable for use in clinical trials.
authors.affiliation: Global Health Division, Menzies School of Health Research and Charles Darwin University, Australia. anna.ralph@menzies.edu.au
authors.forename: Anna P
authors.initials: AP
authors.lastname: Ralph
authors.forename: Muhamed
authors.initials: M
authors.lastname: Ardian
authors.forename: Andri
authors.initials: A
authors.lastname: Wiguna
authors.forename: Graeme P
authors.initials: GP
authors.lastname: Maguire
authors.forename: Niels G
authors.initials: NG
authors.lastname: Becker
authors.forename: Glen
authors.initials: G
authors.lastname: Drogumuller
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wilks
authors.forename: Govert
authors.initials: G
authors.lastname: Waramori
authors.forename: Emiliana
authors.initials: E
authors.lastname: Tjitra
authors.lastname: Sandjaja
authors.forename: Enny
authors.initials: E
authors.lastname: Kenagalem
authors.forename: Gysje J
authors.initials: GJ
authors.lastname: Pontororing
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Anstey
authors.forename: Paul M
authors.initials: PM
authors.lastname: Kelly
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011859:Radiography; D012720:Severity of Illness Index; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging* / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents