title: TBscore II: refining and validating a simple clinical score for treatment monitoring of patients with pulmonary tuberculosis.
abstract: BACKGROUND
  The TBscore, based on simple signs and symptoms, was introduced to predict unsuccessful outcome in tuberculosis patients on treatment. A recent inter-observer variation study showed profound variation in some variables. Further, some variables depend on a physician assessing them, making the score less applicable. The aim of the present study was to simplify the TBscore.
  
  
  METHODS
  Inter-observer variation assessment and exploratory factor analysis were combined to develop a simplified score, the TBscore II. To validate TBscore II we assessed the association between start score and failure (i.e. death or treatment failure), responsiveness using Cohen's effect size, and the relationship between severity class at treatment start and a decrease < 25% in score from the start until the end of the second treatment month and subsequent mortality.
  
  
  RESULTS
  We analyzed data from 1070 Guinean (2003-2012) and 432 Ethiopian (2007-2012) pulmonary tuberculosis patients. For the refined score, items with less than substantial agreement (κ ≤ 0.6) and/or not associated with the underlying constructs were excluded. Items kept were: cough, dyspnea, chest pain, anemia, body mass index (BMI) < 18 kg/m(2), BMI < 16 kg/m(2), mid upper arm circumference (MUAC) < 220 mm, and MUAC < 200 mm. The effect sizes for the change between the start of treatment and the 2-month follow-up were 0.51 in Guinea-Bissau and 0.68 in Ethiopia, and for the change between the start of treatment and the end of treatment were 0.68 in Guinea-Bissau and 0.74 in Ethiopia. Severity class placement at treatment start predicted failure (p < 0.001 Guinea-Bissau, p = 0.208 Ethiopia). Inability to decrease at least 25% in score was associated with a higher failure rate during the remaining 4 months of treatment (p = 0.063 Guinea-Bissau, p = 0.008 Ethiopia).
  
  
  CONCLUSIONS
  The TBscore II could be a useful monitoring tool, aiding triage at the beginning of treatment and during treatment.
authors.affiliation: From the 1 Bandim Health Project, INDEPTH Network , Bissau , Guinea-Bissau.
authors.forename: Frauke
authors.initials: F
authors.lastname: Rudolf
authors.forename: Grethe
authors.initials: G
authors.lastname: Lemvik
authors.forename: Ebba
authors.initials: E
authors.lastname: Abate
authors.forename: Jay
authors.initials: J
authors.lastname: Verkuilen
authors.forename: Thomas
authors.initials: T
authors.lastname: Schön
authors.forename: Victor Francisco
authors.initials: VF
authors.lastname: Gomes
authors.forename: Jesper
authors.initials: J
authors.lastname: Eugen-Olsen
authors.forename: Lars
authors.initials: L
authors.lastname: Østergaard
authors.forename: Christian
authors.initials: C
authors.lastname: Wejse
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D016903:Drug Monitoring / Q000379:methods*; D005002:Ethiopia; D005260:Female; D006169:Guinea-Bissau; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000473:pathology*
chemical_list: D000995:Antitubercular Agents