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Evaluation of Clinical Parameters to Predict Mycobacterium tuberculosis in Inpatients
Juan P. Wisnivesky, MD;
Jennifer Kaplan, MD;
Claudia Henschke, PhD, MD;
Thomas G. McGinn, MD, MPH;
Ronald G. Crystal, MD
Arch Intern Med. 2000;160:2471-2476.
Background Respiratory isolation has been recommended for all patients with suspected tuberculosis (TB) to avoid transmission to other patients and health care personnel. In implementing these guidelines, patients with and without TB are frequently isolated, significantly increasing hospital costs. The objective of this study was to derive a clinical rule to predict the need for respiratory isolation of patients with suspected TB.
Methods To identify potential predictors of the need for isolation, 56 inpatients with sputum cultures positive for TB were retrospectively compared with 56 controls who were isolated on admission to the hospital based on clinically suspected TB but whose sputum cultures tested negative for TB. Variables analyzed included TB risk factors, clinical symptoms, and findings from physical examination and chest radiography.
Results Multivariate analysis revealed that the following factors were significantly associated with a culture positive for TB: presence of TB risk factors or symptoms (odds ratio [OR], 7.9 [95% confidence interval (CI), 4.4-24.2]), a positive purified protein derivative tuberculin test result (OR, 13.2 [95% CI, 4.4-40.7]), high temperature (OR, 2.8 [95% CI, 1.1-8.3]), and upper-lobe disease on chest radiograph (OR, 14.6 [95% CI, 3.7-57.5]). Shortness of breath (OR, 0.2 [95% CI, 0.12-0.53]) and crackles noted during the physical examination (OR, 0.29 [95% CI, 0.15-0.57]) were negative predictors of TB. A scoring system was developed using these variables. A patient's total score of 1 or higher indicated the need for respiratory isolation, accurately predicting a culture positive for TB (98% sensitivity [95% CI, 95%-100%]; 46% specificity [95% CI, 33%-59%]).
Conclusion Among inpatients with suspected active pulmonary TB, a prediction rule based on clinical and chest radiographic findings accurately identified patients requiring respiratory isolation.
From the Division of Pulmonary and Critical Care Medicine (Drs Wisnivesky and Crystal) and the Department of Radiology (Drs Kaplan and Henschke), Weill Medical College of Cornell University, New York–Presbyterian Hospital, and the Division of General Internal Medicine, Department of Medicine (Dr McGinn), Mount Sinai School of Medicine, New York, NY. Dr Wisnivesky is now with the Division of General Internal Medicine, Department of Medicine, Mount Sinai School of Medicine.
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