Van Wyk S S, Lin H H, Claassens M M
Department of Paediatrics and Child Health, Desmond Tutu Tuberculosis Centre, Stellenbosch University, Cape Town, South Africa.
Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taiwan.
Int J Tuberc Lung Dis. 2017 Apr 1;21(4):405-411. doi: 10.5588/ijtld.16.0059.
A systematic review was conducted to describe the quality and characteristics of prediction models for prevalent pulmonary tuberculosis (PTB) in adults at routine TB care settings. A prediction model was defined as the combination of two or more clinical predictors designed to estimate the probability of having TB. Studies using culture-confirmed PTB as reference standard were included. Models for in-patients, children or specific patient populations were excluded. PubMed, Scopus and the Cochrane Library and abstracts from the International Union Against Tuberculosis and Lung Disease, American Thoracic Society and European Respiratory Society conferences were searched. The CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) checklist was used for data extraction and quality assessment. From 13 671 identified records, six were included for data extraction; three assessed smear-negative, culture-positive PTB as outcome and three focused on human immunodeficiency virus infected individuals only. Reporting of model development, performance and evaluation was poor. In four studies, predictive performance was evaluated using the development data set (apparent performance), one study did an internal validation and one study did an external validation. Results were not pooled due to heterogeneity. Existing prediction models for estimating prevalent PTB in adults at primary care level are poorly reported and validated and are not useful for TB screening. The World Health Organization symptom screen is recommended.
开展了一项系统评价，以描述在结核病常规诊疗环境中用于预测成人肺结核（PTB）患病率的预测模型的质量和特征。预测模型定义为两个或更多临床预测指标的组合，旨在估计患结核病的概率。纳入了以培养确诊的PTB作为参考标准的研究。排除了针对住院患者、儿童或特定患者群体的模型。检索了PubMed、Scopus和Cochrane图书馆以及国际防痨和肺部疾病联盟、美国胸科学会和欧洲呼吸学会会议的摘要。使用CHARM（预测模型研究系统评价的关键评估和数据提取）清单进行数据提取和质量评估。从13671条已识别记录中，纳入6条进行数据提取；3项研究将涂片阴性、培养阳性的PTB作为结局进行评估，3项研究仅关注人类免疫缺陷病毒感染个体。模型开发、性能和评估的报告情况较差。4项研究使用开发数据集评估预测性能（表观性能），1项研究进行了内部验证，1项研究进行了外部验证。由于异质性，未汇总结果。在基层医疗层面，现有的用于估计成人PTB患病率的预测模型报告和验证不足，对结核病筛查无用。建议采用世界卫生组织症状筛查。
