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Decision Instrument of Moran for Identifying a Patient with Pneumonia in the Emergency Department Who May Have Tuberculosis

Description

Moran et al identified factors associated with pulmonary tuberculosis in a patient in the Emergency Department with pneumonia. These can help to identify a patient who should or should not be placed in isolation. The authors are from University of California Los Angeles, Vanderbilt University and the Centers for Disease Control and Prevention.


Patient selection: adult with pneumonia in the emergency department

 

Predictors for tuberculosis:

(1) history of tuberculosis or a positive tuberculin skin test (odds ratio 2.9)

(2) immigrant (odds ratio 4.6)

(3) homeless (odds ratio 1.6)

(4) history of incarceration (odds ratio 1.6)

(5) recent weight loss (odds ratio 4.1)

(6) chest X-ray with apical infiltrate (odds ratio 7.9)

(7) chest X-ray with a cavitary lesion (odds ratio 8.8)

 

A patient with none of these predictors is low risk for tuberculosis and probably does not need to be placed in isolation.

 

Performance:

• The negative predictive value was 99.7%.

• The sensitivity was 96% and specificity 49%.


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