title: Towards probabilistic decision support in public health practice: predicting recent transmission of tuberculosis from patient attributes.
abstract: OBJECTIVE
  Investigating the contacts of a newly diagnosed tuberculosis (TB) case to prevent TB transmission is a core public health activity. In the context of limited resources, it is often necessary to prioritize investigation when multiple cases are reported. Public health personnel currently prioritize contact investigation intuitively based on past experience. Decision-support software using patient attributes to predict the probability of a TB case being involved in recent transmission could aid in this prioritization, but a prediction model is needed to drive such software.
  
  
  METHODS
  We developed a logistic regression model using the clinical and demographic information of TB cases reported to Montreal Public Health between 1997 and 2007. The reference standard for transmission was DNA fingerprint analysis. We measured the predictive performance, in terms of sensitivity, specificity, negative predictive value, positive predictive value, the Receiver Operating Characteristic (ROC) curve and the Area Under the ROC (AUC).
  
  
  RESULTS
  Among 1552 TB cases enrolled in the study, 314 (20.2%) were involved in recent transmission. The AUC of the model was 0.65 (95% confidence interval: 0.61-0.68), which is significantly better than random prediction. The maximized values of sensitivity and specificity on the ROC were 0.53 and 0.67, respectively.
  
  
  CONCLUSIONS
  The characteristics of a TB patient reported to public health can be used to predict whether the newly diagnosed case is associated with recent transmission as opposed to reactivation of latent infection.
authors.affiliation: McGill Clinical and Health Informatics, McGill University, 1140 Avenue Pine, Montréal, Québec H3A 1A3, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada. Electronic address: hiroshi.mamiya@mail.mcgill.ca.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mamiya
authors.affiliation: Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, 3650 Rue Saint-Urbain, Montreal, Quebec H2X 2P4, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada; McGill International TB Centre, McGill University Health Centre, 1650 Cedar Avenue, Room A5.156, Montreal, Quebec, H3G 1A4, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Schwartzman
authors.affiliation: McGill Clinical and Health Informatics, McGill University, 1140 Avenue Pine, Montréal, Québec H3A 1A3, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada.
authors.forename: Aman
authors.initials: A
authors.lastname: Verma
authors.affiliation: McGill Clinical and Health Informatics, McGill University, 1140 Avenue Pine, Montréal, Québec H3A 1A3, Canada.
authors.forename: Christian
authors.initials: C
authors.lastname: Jauvin
authors.affiliation: McGill University Health Centre, 1650 Cedar Avenue, Room A5.156, Montreal, H3G 1A4, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada; McGill International TB Centre, McGill University Health Centre, 1650 Cedar Avenue, Room A5.156, Montreal, Quebec, H3G 1A4, Canada.
authors.forename: Marcel
authors.initials: M
authors.lastname: Behr
authors.affiliation: McGill Clinical and Health Informatics, McGill University, 1140 Avenue Pine, Montréal, Québec H3A 1A3, Canada; Agence Sociosanitaire de Montréal, Direction de la santé publique, 1301 Rue Sherbrooke Est, Montreal, Quebec H2L 1M3, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Buckeridge
mesh_terms: D000328:Adult; D000465:Algorithms; D019540:Area Under Curve; D001499:Bayes Theorem; D019295:Computational Biology / Q000379:methods*; D003661:Decision Support Techniques; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D040442:Public Health Informatics; D011792:Quebec; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014376:Tuberculosis / Q000175:diagnosis* / Q000635:transmission*
keywords: Decision support model; Public health; Statistical prediction; Transmission; Tuberculosis