title: Systematic review with meta-analyses and critical appraisal of clinical prediction rules for pulmonary tuberculosis in hospitals.
abstract: OBJECTIVE
  To systematically review studies evaluating clinical prediction rules (CPRs) for adult inpatients suspected to have pulmonary tuberculosis.
  
  
  METHODS
  Systematic review with meta-analyses.
  
  
  METHODS
  Hospitals. Patients Inpatients at least 15 years of age admitted to acute care.
  
  
  METHODS
  A search was conducted in 5 indexed electronic databases with no language or year of publication restrictions. We performed a meta-analysis for those CPRs with at least 2 validation studies. Results were reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
  
  
  RESULTS
  Of the 461 abstracts selected, 36 articles were fully analyzed and 11 articles were included, yielding 8 CPRs derived in 4 countries. Broad validation studies were identified for 2 CPRs. The most frequent clinical predictors were fever and weight loss. All CPRs included chest imaging signs. Most CPRs were derived in countries with a low prevalence of pulmonary tuberculosis and included homeless, immigrants, and those who reacted to the purified protein derivative test. Both of the CPRs derived in countries with a high prevalence of pulmonary tuberculosis strongly relied on chest radiograph predictors. Accuracy of the different CPRs was high (area under receiver operating characteristic curve, 0.79-0.91). Meta-analysis of 4 validation studies for Wisnivesky's CPR indicates optimistic pooled results: sensitivity, 94.1% (95% CI, 89.7%-96.7%); negative likelihood ratio, 0.22 (95% CI, 0.12-0.40).
  
  
  CONCLUSIONS
  On the basis of a critical appraisal of the 2 best validated CPRs, the presence of weight loss and/or fever in inpatients warrants obtaining a chest radiograph, regardless of the presence of productive cough. If the chest radiograph is abnormal, the patient should be placed in isolation until more specific test results are available. Validation in different settings is required to maximize external generalization of existing CPRs.
authors: 1Federal University Fluminense,Niterói,RJ,Brazil.
authors: Berenice das Dores
authors: Bd
authors: Gonçalves
authors: 2National Institute of Infectious Disease EvandroChagas/Oswaldo Cruz Foundation/Laboratory of Clinical Epidemiology,Rio de Janeiro,RJ,Brazil.
authors: Sonia Regina
authors: SR
authors: Lambert Passos
authors: 3National School of Public Health,Oswaldo Cruz Foundation,Rio de Janeiro,RJ,Brazil.
authors: Maria Angelica
authors: MA
authors: Borges Dos Santos
authors: 2National Institute of Infectious Disease EvandroChagas/Oswaldo Cruz Foundation/Laboratory of Clinical Epidemiology,Rio de Janeiro,RJ,Brazil.
authors: Carlos Augusto Ferreira
authors: CA
authors: de Andrade
authors: 4Oswaldo Cruz Foundation Libraries' Network/ Institute of Scientific and Technological Information and Communication in Health/ Oswaldo Cruz Foundation,Rio de Janeiro,RJ,Brazil.
authors: Maria de Fátima
authors: Mde F
authors: Moreira Martins
authors: 5Thoracic Diseases Institute,Medical School of the Federal University of Rio de Janeiro,Rio de Janeiro,RJ,Brazil.
authors: Fernanda Carvalho
authors: FC
authors: de Queiroz Mello
mesh_terms: D019540:Area Under Curve; D003661:Decision Support Techniques; D005334:Fever / Q000382:microbiology; D006761:Hospitals; D006801:Humans; D012372:ROC Curve; D011859:Radiography; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D015431:Weight Loss