Doctoral Program in Public Health, Graduate School, Universitas Sebelas Maret, Surakarta, Indonesia.
Department of Pulmonology and Respiratory Medicine, Dr. Soetomo General Hospital/Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
BMC Pulm Med. 2022 May 26;22(1):208. doi: 10.1186/s12890-022-02001-2.
There is a growing concern on how to increase tuberculosis (TB) case detection in resource-poor settings. The healthcare facilities routinely providing services to the elderly for chronic diseases often failed to detect TB cases, causing a missed opportunity. This study aimed to develop a simple and sensitive screening tool using signs, symptoms, and risk factors for TB case detection in the elderly.
This was a cross-sectional study conducted from August to December 2020. A random sample of 302 subjects was taken from the elderly aged ≥ 60 years attending the outpatient polyclinic at Mangunharjo hospital, Madiun, East Java, Indonesia, for a chronic disease problem. The test was developed using 16 TB signs, symptoms, and risk factors. Test performance was assessed by comparing it against the GeneXpert MTB/RIF.
Marginal analysis resulted in the optimal cut-point of ≥ 7 for the test, which gave an area under the curve (AUC) of 0.62, with the maximum marginal AUC of 0.04 (p < 0.001). The sensitivity and specificity were 60.26% and 64.29%, meaning 60 TB cases for every 100 elderly with TB would be otherwise left undetected if this screening test did not take place.
A simple TB screening tool with moderate sensitivity and AUC has been developed using TB signs, symptoms, and risk factors. It can be used as an initial step of the systematic TB screening in the elderly visiting healthcare facilities for routine chronic disease examination, with the additional utility of reducing the missed opportunity.
如何在资源匮乏的环境中增加结核病（TB）病例检出率，这一问题引发了广泛关注。为慢性病患者提供常规服务的医疗保健机构往往未能发现结核病病例，导致错失了很多机会。本研究旨在开发一种简单而敏感的筛查工具，利用与老年人 TB 病例检出相关的体征、症状和危险因素。
这是一项横断面研究，于 2020 年 8 月至 12 月在印度尼西亚东爪哇省马古纳哈里乔医院的门诊诊所进行。从 302 名年龄≥60 岁的老年人中随机抽取样本，这些老年人因慢性疾病问题前来就诊。该检测使用了 16 项 TB 体征、症状和危险因素进行开发。通过将其与 GeneXpert MTB/RIF 进行比较来评估检测性能。
边缘分析得出测试的最佳截断值为≥7，曲线下面积（AUC）为 0.62，最大边缘 AUC 为 0.04（p<0.001）。灵敏度和特异性分别为 60.26%和 64.29%，这意味着如果不进行这种筛查测试，每 100 名患有结核病的老年人中就会有 60 例被漏诊。
利用 TB 体征、症状和危险因素开发了一种具有中等灵敏度和 AUC 的简单 TB 筛查工具。它可以作为老年人在接受常规慢性疾病检查时进行系统 TB 筛查的初步步骤，还可以减少漏诊的机会。
