Solari et al reported a clinical prediction rule for the diagnosis of pleural tuberculosis in a patient in Peru. This can help to identify a patient who can be started on therapy without a pleural biopsy. The authors are from the Institute of Tropical Medicine Antwerp, Instituto Nacional de Salud, Universidad Peruana de Ciencias Aplicados, Hospital Nacional Hipolito Unanue and Ghent University.
Patient selection: exudative pleural effusion
Parameters:
(1) age in years
(2) sex
(3) history of contact with a patient with tuberculosis
(4) lymphadenopathy
(5) adenosine deaminase (ADA) in pleural fluid IU/L
Parameter
Findiing
Points
age in years
(-0.7 * (age))
sex
male
12
female
0
history of TB contact
no
0
yes
13
lymphadenopathy
no
0
yes
-19
pleural fluid ADA
0.4 * (ADA)
score =
= SUM(points for the 5 parameters) + 70
Interpretation:
• minimum score: around -20
• maximum score: around 125
• A score >= 60 is associated with pleural tuberculosis.
• A pleural fluid ADA >= 30 IU/L was associated with pleural tuberculosis.
Performance:
• The area under the ROC curve is 0.92.
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