Service de Pédiatrie, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda.
Pediatr Infect Dis J. 2010 Feb;29(2):e11-8. doi: 10.1097/INF.0b013e3181c61ddb.
A pediatric ward of a university hospital in Kigali, Rwanda, a region with a high HIV seroprevalence.
To estimate the diagnostic accuracy of symptoms, signs, and paraclinical investigations for tuberculosis in children, and to propose a clinical rule based on the results.
During a 2-year period all children with cough for more than 2 weeks and/or fever for more than 2 weeks and/or reported weight loss were prospectively included. A set of clinical and paraclinical data were analyzed with latent class analysis. Comparison of post-test probability based on this analysis with a therapeutic threshold for TB was used to develop a guideline.
In the 309 children HIV prevalence was 56%, bacteriology was positive in 9%, and the tuberculin skin test (TST) was >10 mm in 20%. TB prevalence was 32%. Bacteriology and TST had a specificity of 97% and cough had a sensitivity of 91%. Decision analysis suggests treating children presenting one of the inclusion criteria, combined with positive bacteriology or TST >10 mm or contact with a TB patient.
Latent class analysis confirmed earlier identified predictors for TB and allowed development of an easy to use clinical rule, applicable in reference hospitals of countries with high HIV endemicity.
卢旺达基加利一所大学医院的儿科病房，该地区艾滋病毒血清阳性率很高。
评估症状、体征和辅助检查对儿童结核病的诊断准确性，并根据结果提出临床规则。
在两年期间，所有咳嗽超过 2 周和/或发热超过 2 周和/或报告体重减轻的儿童均前瞻性纳入。使用潜在类别分析对一组临床和辅助数据进行分析。基于该分析的后验概率与结核病的治疗阈值进行比较，用于制定指南。
在 309 名儿童中，艾滋病毒流行率为 56%，细菌学阳性率为 9%，结核菌素皮肤试验（TST）>10 毫米的比例为 20%。结核病的流行率为 32%。细菌学和 TST 的特异性为 97%，咳嗽的敏感性为 91%。决策分析建议治疗符合以下纳入标准之一的儿童，同时伴有细菌学阳性或 TST>10 毫米或与结核病患者接触。
潜在类别分析证实了之前确定的结核病预测因素，并开发了一种易于使用的临床规则，适用于艾滋病毒流行率高的国家的参考医院。
