Development and evaluation of tuberculosis screening scores in Brazilian prisons.
Public Health
; 120(10): 976-83, 2006 Oct.
Article
en En
| MEDLINE
| ID: mdl-16965796
ABSTRACT
BACKGROUND:
Tuberculosis (TB) is highly endemic in Rio de Janeiro State prisons. In addition to TB screening at entry and passive case detection, active case identification may be warranted.OBJECTIVES:
To develop and evaluate performances of scores aimed at identifying "tuberculosis suspects" in order to target TB screening among inmates.METHODS:
Systematic chest X-ray screening was carried out in two prisons (n=1910). TB was diagnosed among individuals with X-ray abnormalities by sputum microscopic examination and culture or, if bacteriological results were negative, by response to TB treatment. Using this strategy as a reference, the clinical score proposed in WHO guidelines "TB Control in Prisons" was evaluated. Using the same variables in a logistic regression comparing TB and non-TB cases, another score was developed and evaluated. Finally, a 'new score', based on socio-demographic and clinical variables was developed and evaluated.RESULTS:
When applied to our study population (prevalence of active TB 4.6%), these scores missed many TB cases (sensitivities 56%, 72%, 74%, respectively). Among the "TB suspects", the probability of finding TB cases was low (positive predictive value 10%). The scores had high negative predictive values (>97%); specificities (75%, 60%, 67%) were low. Performances were similarly poor for smear-negative and smear-positive cases.CONCLUSION:
The scores investigated performed poorly and would be unhelpful to target TB screening. Therefore, systematic X-ray screening may be considered, at least during the initial stages of the reinforced TB programme, in order to reduce the impressive burden of TB.
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Prisioneros
/
Tuberculosis
/
Tamizaje Masivo
Tipo de estudio:
Diagnostic_studies
/
Evaluation_studies
/
Guideline
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Screening_studies
Límite:
Adult
/
Humans
/
Male
/
Middle aged
País/Región como asunto:
America do sul
/
Brasil
Idioma:
En
Revista:
Public Health
Año:
2006
Tipo del documento:
Article
País de afiliación:
Francia