title: Diagnostic Test Accuracy in Childhood Pulmonary Tuberculosis: A Bayesian Latent Class Analysis.
abstract: Evaluation of tests for the diagnosis of childhood pulmonary tuberculosis (CPTB) is complicated by the absence of an accurate reference test. We present a Bayesian latent class analysis in which we evaluated the accuracy of 5 diagnostic tests for CPTB. We used data from a study of 749 hospitalized South African children suspected to have CPTB from 2009 to 2014. The following tests were used: mycobacterial culture, smear microscopy, Xpert MTB/RIF (Cepheid Inc.), tuberculin skin test (TST), and chest radiography. We estimated the prevalence of CPTB to be 27% (95% credible interval (CrI): 21, 35). The sensitivities of culture, Xpert, and smear microscopy were estimated to be 60% (95% CrI: 46, 76), 49% (95% CrI: 38, 62), and 22% (95% CrI: 16, 30), respectively; specificities of these tests were estimated in accordance with prior information and were close to 100%. Chest radiography was estimated to have a sensitivity of 64% (95% CrI: 55, 73) and a specificity of 78% (95% CrI: 73, 83). Sensitivity of the TST was estimated to be 75% (95% CrI: 61, 84), and it decreased substantially among children who were malnourished and infected with human immunodeficiency virus (56%). The specificity of the TST was 69% (95% CrI: 63%, 76%). Furthermore, it was estimated that 46% (95% CrI: 42, 49) of CPTB-negative cases and 93% (95% CrI: 82; 98) of CPTB-positive cases received antituberculosis treatment, which indicates substantial overtreatment and limited undertreatment.
authors.forename: Samuel G
authors.initials: SG
authors.lastname: Schumacher
authors.forename: Maarten
authors.initials: M
authors.lastname: van Smeden
authors.forename: Nandini
authors.initials: N
authors.lastname: Dendukuri
authors.forename: Lawrence
authors.initials: L
authors.lastname: Joseph
authors.forename: Mark P
authors.initials: MP
authors.lastname: Nicol
authors.forename: Madhukar
authors.initials: M
authors.lastname: Pai
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Zar
mesh_terms: D001431:Bacteriological Techniques / Q000379:methods; D001499:Bayes Theorem; D002675:Child, Preschool; D060085:Coinfection / Q000175:diagnosis; D005260:Female; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000175:diagnosis*; D006300:Health Services Misuse / Q000517:prevention & control / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D009161:Mycobacterium / Q000302:isolation & purification*; D021141:Nucleic Acid Amplification Techniques; D013902:Radiography, Thoracic; D012015:Reference Standards; D012680:Sensitivity and Specificity; D013019:South Africa; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*
keywords:  specificity; childhood pulmonary tuberculosis; diagnosis; latent class analysis; overtreatment; sensitivity