Centre for International Child Health, University of Melbourne, Department of Pediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, Victoria, 3052, Australia.
Indian J Pediatr. 2011 Mar;78(3):334-9. doi: 10.1007/s12098-010-0307-7. Epub 2010 Dec 17.
Effective management of tuberculosis (TB) in children and important data of disease burden continue to rely on a clinical approach to diagnosis, as diagnosis of childhood TB is not confirmed in the majority. Many diagnostic scoring systems have been developed to aid with diagnosis. This article reviews the use and evaluation of these approaches. The diagnostic systems are often closely related and all rely on the well-known clinical features associated with TB disease in children. The scoring systems are not well validated and validation is limited by the lack of a gold standard for comparison. When they have been validated, some systems perform reasonably well but may bias to identify the most obvious clinical cases. They perform less well in important sub-groups that pose the greatest diagnostic challenge and are at greatest risk for poor outcome, such as the young, malnourished or HIV-infected. There is marked variation in performance between these diagnostic approaches. The better validated systems may have a role as a screening tool in some settings, but this would need careful consideration as to the most useful and safest approach. More attention is being given to improving diagnosis and management of child TB, including within National TB Programmes. Research with new diagnostics should include children so that there is less reliance on clinical features alone. However, the clinical approach will continue to be relevant and so it is important to strive to improve the diagnostic approach to TB in children, and to validate the approach in different settings.
儿童结核病的有效管理和疾病负担的重要数据仍然依赖于临床诊断方法，因为大多数情况下儿童结核病的诊断并未得到确认。为此，已经开发了许多诊断评分系统来辅助诊断。本文回顾了这些方法的使用和评估。这些诊断系统通常密切相关，都依赖于众所周知的与儿童结核病相关的临床特征。评分系统尚未得到充分验证，验证受到缺乏金标准进行比较的限制。在验证后，一些系统表现良好，但可能会偏向于识别最明显的临床病例。它们在构成最大诊断挑战和预后最差风险最大的重要亚组中的表现较差，例如年幼、营养不良或感染 HIV 的儿童。这些诊断方法的性能存在明显差异。在某些情况下，经过更好验证的系统可能可以作为筛选工具，但需要仔细考虑最有用和最安全的方法。目前，人们越来越关注改进儿童结核病的诊断和管理，包括在国家结核病规划中。包括儿童在内的新诊断方法的研究可以减少对临床特征的单独依赖。然而，临床方法仍将具有相关性，因此，努力改进儿童结核病的诊断方法并在不同环境中验证该方法非常重要。
