Evaluation of clinical parameters to predict Mycobacterium tuberculosis in inpatients

J. P. Wisnivesky, J. Kaplan, C. Henschke, T. G. McGinn, Ronald Crystal

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Background: Respiratory isolation has been recommended for all patients with suspected tuberculosis (TB) to avoid transmission to other patients and health care personnel. In implementing these guidelines, patients with and without TB are frequently isolated, significantly increasing hospital costs. The objective of this study was to derive a clinical rule to predict the need for respiratory isolation of patients with suspected TB. Methods: To identify potential predictors of the need for isolation, 56 inpatients with sputum cultures positive for TB were retrospectively compared with 56 controls who were isolated on admission to the hospital based on clinically suspected TB but whose sputum cultures tested negative for TB. Variables analyzed included TB risk factors, clinical symptoms, and findings from physical examination and chest radiography. Results: Multivariate analysis revealed that the following factors were significantly associated with a culture positive for TB: presence of TB risk factors or symptoms (odds ratio [OR], 7.9 [95% confidence interval (CI), 4.4-24.2]), a positive purified protein derivative tuberculin test result (OR, 13.2 [95% CI, 4.4-40.7]), high temperature (OR, 2.8 [95% CI, 1.1-8.3]), and upper-lobe disease on chest radiograph (OR, 14.6 [95% CI, 3.7-57.5]). Shortness of breath (OR, 0.2 [95% CI, 0.12-0.53]) and crackles noted during the physical examination (OR, 0.29 [95% CI, 0.15-0.57]) were negative predictors of TB. A scoring system was developed using these variables. A patient's total score of 1 or higher indicated the need for respiratory isolation, accurately predicting a culture positive for TB (98% sensitivity [95% CI, 95%-100%]; 46% specificity [95% CI, 33%-59%]). Conclusion: Among inpatients with suspected active pulmonary TB, a prediction rule based on clinical and chest radiographic findings accurately identified patients requiring respiratory isolation.

Original languageEnglish
Pages (from-to)2471-2476
Number of pages6
JournalArchives of Internal Medicine
Volume160
Issue number16
Publication statusPublished - 11 Sep 2000
Externally publishedYes

Fingerprint

Mycobacterium tuberculosis
Inpatients
Tuberculosis
Confidence Intervals
Odds Ratio
Thorax
Sputum
Physical Examination
Patient Isolation
Tuberculin Test
Hospital Costs
Tuberculin
Respiratory Sounds
Pulmonary Tuberculosis
Radiography
Health Personnel
Dyspnea
Patient Care
Multivariate Analysis
Guidelines

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Wisnivesky, J. P., Kaplan, J., Henschke, C., McGinn, T. G., & Crystal, R. (2000). Evaluation of clinical parameters to predict Mycobacterium tuberculosis in inpatients. Archives of Internal Medicine, 160(16), 2471-2476.

Evaluation of clinical parameters to predict Mycobacterium tuberculosis in inpatients. / Wisnivesky, J. P.; Kaplan, J.; Henschke, C.; McGinn, T. G.; Crystal, Ronald.

In: Archives of Internal Medicine, Vol. 160, No. 16, 11.09.2000, p. 2471-2476.

Research output: Contribution to journalArticle

Wisnivesky, JP, Kaplan, J, Henschke, C, McGinn, TG & Crystal, R 2000, 'Evaluation of clinical parameters to predict Mycobacterium tuberculosis in inpatients', Archives of Internal Medicine, vol. 160, no. 16, pp. 2471-2476.
Wisnivesky, J. P. ; Kaplan, J. ; Henschke, C. ; McGinn, T. G. ; Crystal, Ronald. / Evaluation of clinical parameters to predict Mycobacterium tuberculosis in inpatients. In: Archives of Internal Medicine. 2000 ; Vol. 160, No. 16. pp. 2471-2476.
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