title: Reader variability and validation of the Timika X-ray score during treatment of pulmonary tuberculosis.
abstract: Chest radiographs (CXRs) are widely used for diagnosing pulmonary TB and assessing response to therapy. The Timika X-ray score has been proposed as a tool for measuring disease severity and predicting treatment outcome.
  
  
  
  To evaluate inter- and intra-reader agreement of Timika scores and assess the ability of the score to predict microbiologic outcome at 2 months.
  
  
  
  Analytical validation study. Disease severity was measured by two readers using pretreatment radiographs and follow-up films taken at 2, 6 and 12 months after the start of treatment among 110 human immunodeficiency virus negative adults with pulmonary TB. One fourth of the films were reread to assess intra-reader agreement.
  
  
  
  The two-component Timika score had high inter- and intra-reader agreement (intraclass correlation (ICC)inter= 75%, ICCintra> 0.81). Baseline Timika score was associated with positive month 2 smear (P = 0.0004) and culture status (P = 0.03). The average Timika score declined significantly over the course of successful treatment.
  
  
  
  The Timika score showed good inter- and intra-reader agreement and a significant association with microbiological outcomes after 2 months of treatment. The results of this study strengthen the evidence supporting the use of the Timika score for measuring disease severity on CXR.
authors.affiliation: Tuberculosis Research Unit, Department of Medicine, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio, USA; Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda.
authors.forename: B A
authors.initials: BA
authors.lastname: Thiel
authors.affiliation: Tuberculosis Research Unit, Department of Medicine, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio, USA; Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda, Division of Infectious Diseases, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Bark
authors.affiliation: Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda.
authors.forename: J G
authors.initials: JG
authors.lastname: Nakibali
authors.affiliation: Division of Infectious Diseases, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: F
authors.initials: F
authors.lastname: van der Kuyp
authors.affiliation: Tuberculosis Research Unit, Department of Medicine, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio, USA; Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda.
authors.forename: J L
authors.initials: JL
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D015992:Body Mass Index; D001835:Body Weight; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D015588:Observer Variation; D011379:Prognosis; D011859:Radiography / Q000379:methods*; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging* / Q000188:drug therapy; D014965:X-Rays; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents