Gonçalves Berenice das Dores, Lambert Passos Sonia Regina, Borges Dos Santos Maria Angelica, de Andrade Carlos Augusto Ferreira, Moreira Martins Maria de Fátima, de Queiroz Mello Fernanda Carvalho
1Federal University Fluminense,Niterói,RJ,Brazil.
2National Institute of Infectious Disease EvandroChagas/Oswaldo Cruz Foundation/Laboratory of Clinical Epidemiology,Rio de Janeiro,RJ,Brazil.
Infect Control Hosp Epidemiol. 2015 Feb;36(2):204-13. doi: 10.1017/ice.2014.29.
To systematically review studies evaluating clinical prediction rules (CPRs) for adult inpatients suspected to have pulmonary tuberculosis.
Systematic review with meta-analyses.
Hospitals. Patients Inpatients at least 15 years of age admitted to acute care.
A search was conducted in 5 indexed electronic databases with no language or year of publication restrictions. We performed a meta-analysis for those CPRs with at least 2 validation studies. Results were reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Of the 461 abstracts selected, 36 articles were fully analyzed and 11 articles were included, yielding 8 CPRs derived in 4 countries. Broad validation studies were identified for 2 CPRs. The most frequent clinical predictors were fever and weight loss. All CPRs included chest imaging signs. Most CPRs were derived in countries with a low prevalence of pulmonary tuberculosis and included homeless, immigrants, and those who reacted to the purified protein derivative test. Both of the CPRs derived in countries with a high prevalence of pulmonary tuberculosis strongly relied on chest radiograph predictors. Accuracy of the different CPRs was high (area under receiver operating characteristic curve, 0.79-0.91). Meta-analysis of 4 validation studies for Wisnivesky's CPR indicates optimistic pooled results: sensitivity, 94.1% (95% CI, 89.7%-96.7%); negative likelihood ratio, 0.22 (95% CI, 0.12-0.40).
On the basis of a critical appraisal of the 2 best validated CPRs, the presence of weight loss and/or fever in inpatients warrants obtaining a chest radiograph, regardless of the presence of productive cough. If the chest radiograph is abnormal, the patient should be placed in isolation until more specific test results are available. Validation in different settings is required to maximize external generalization of existing CPRs.
系统评价评估疑似患有肺结核的成年住院患者临床预测规则（CPRs）的研究。
系统评价并进行荟萃分析。
医院。患者为至少15岁的急性护理住院患者。
在5个索引电子数据库中进行检索，无语言或出版年份限制。对至少有2项验证研究的CPRs进行荟萃分析。结果根据系统评价和荟萃分析的首选报告项目进行报告。
在筛选出的461篇摘要中，对36篇文章进行了全面分析，纳入11篇文章，产生了在4个国家得出的8种CPRs。确定了对2种CPRs进行的广泛验证研究。最常见的临床预测因素是发热和体重减轻。所有CPRs都包括胸部影像学征象。大多数CPRs是在肺结核患病率低的国家得出的，包括无家可归者﹑移民以及对纯化蛋白衍生物试验有反应的人。在肺结核患病率高的国家得出的两种CPRs都强烈依赖胸部X线片预测因素。不同CPRs的准确性较高（受试者工作特征曲线下面积，0.79 - 0.91）。对Wisnivesky的CPR的4项验证研究的荟萃分析表明汇总结果乐观：敏感性为94.1%（95%CI，89.7% - 96.7%）；阴性似然比为0.22（95%CI，0.12 - 0.40）。
基于对2种验证最佳的CPRs的批判性评价，住院患者出现体重减轻和/或发热时，无论有无咳痰，均需进行胸部X线检查。如果胸部X线检查异常，在获得更具体的检查结果之前，应将患者隔离。需要在不同环境中进行验证，以最大限度地扩大现有CPRs的外部推广性。
