Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.
Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
Pediatrics. 2023 Apr 1;151(4). doi: 10.1542/peds.2022-059189.
Improving detection of pediatric tuberculosis (TB) is critical to reducing morbidity and mortality among children.
We conducted a systematic review to estimate the number of children needed to screen (NNS) to detect a single case of active TB using different active case finding (ACF) screening approaches and across different settings.
We searched 4 databases (PubMed, Embase, Scopus, and the Cochrane Library) for articles published from November 2010 to February 2020.
We included studies of TB ACF in children using symptom-based screening, clinical indicators, chest x-ray, and Xpert.
We indirectly estimated the weighted mean NNS for a given modality, location, and population using the inverse of the weighted prevalence. We assessed risk of bias using a modified AXIS tool.
We screened 27 221 titles and abstracts, of which we included 31 studies of ACF in children < 15 years old. Symptom-based screening was the most common screening modality (weighted mean NNS: 257 [range, 5-undefined], 19 studies). The weighted mean NNS was lower in both inpatient (216 [18-241]) and outpatient (67 [5-undefined]) settings (107 [5-undefined]) compared with community (1117 [28-5146]) and school settings (464 [118-665]). Risk of bias was low.
Heterogeneity in the screening modalities and populations make it difficult to draw conclusions.
We identified a potential opportunity to increase TB detection by screening children presenting in health care settings. Pediatric TB case finding interventions should incorporate evidence-based interventions and local contextual information in an effort to detect as many children with TB as possible.
提高儿童结核病（TB）的检出率对于降低儿童发病率和死亡率至关重要。
我们进行了一项系统评价，以估计使用不同的活动性病例发现（ACF）筛查方法和不同的环境下，筛查一个活动性结核病病例所需的儿童人数（NNS）。
我们从 2010 年 11 月至 2020 年 2 月在 4 个数据库（PubMed、Embase、Scopus 和 Cochrane Library）中搜索了文章。
我们纳入了使用基于症状的筛查、临床指标、胸部 X 线和 Xpert 进行儿童 TB ACF 的研究。
我们使用加权患病率的倒数间接估计给定模式、地点和人群的加权平均 NNS。我们使用改良的 AXIS 工具评估偏倚风险。
我们筛选了 27221 篇标题和摘要，其中包括 31 项儿童 ACF 的研究，年龄<15 岁。基于症状的筛查是最常见的筛查方式（加权平均 NNS：257[范围，5-未定义]，19 项研究）。与社区（1117[28-5146]）和学校（464[118-665]）环境相比，住院（216[18-241]）和门诊（67[5-未定义]）环境中的加权平均 NNS 较低。偏倚风险较低。
筛查方式和人群的异质性使得难以得出结论。
我们发现通过在医疗保健环境中筛查出现的儿童，有增加结核病检出率的潜在机会。儿科结核病病例发现干预措施应结合循证干预措施和当地背景信息，以尽可能多地发现结核病儿童。
