The Pediatric Tuberculosis Score Chart allows evaluation of children suspected of having tuberculosis, especially in developing countries where tuberculosis is prevalent and diagnostic resources are limited.
|
Feature |
Finding |
Score |
|
length of illness |
< 2 weeks |
0 |
|
|
2 - 4 weeks |
1 |
|
|
> 4 weeks |
3 |
|
nutrition and weight |
> 80% for age |
0 |
|
|
60 - 80% for age |
1 |
|
|
< 60% for age |
3 |
|
family tuberculosis in past or present |
none |
0 |
|
|
reported by family |
1 |
|
|
proved sputum positive |
3 |
|
Feature |
Score |
|
positive tuberculin test |
3 |
|
large painless lymph nodes; firm, soft, sinus in neck, axilla or groin |
3 |
|
unexplained fever, night sweats, no response to malaria treatment |
2 |
|
malnutrition, not improving after 4 weeks |
3 |
|
angle deformity of spine |
4 |
|
joint swelling, bone swelling or sinuses |
3 |
|
unexplained abdominal mass or ascites |
3 |
|
change in temperament, fits or coma (CNS signs) |
3 |
score =
= SUM(points for all features and findings present)
Interpretation:
• minimum score: 0
• maximum score: 34
Management Algorithm for Third World Conditions:
(1) If the patient shows CNS signs, then send to a hospital if possible.
(2) If the score is >= 7, then treat for tuberculosis.
(3) If the (a) presentation suggests pneumonia, (b) there are no other signs of tuberculosis, and (c) the score is 1-6:
(3a) If a chest radiograph is consistent with tuberculosis, then treat for tuberculosis.
(3b) If no chest radiograph is available, or if the chest radiograph is not diagnostic for tuberculosis, then treat the patient with a one week course of high dose antibiotic. If this fails to cause improvement, then try a second course with a different antibiotic. If this fails to cause improvement, then treat for tuberculosis.
Limitations:
• van Rheenen found that the score was sensitive but not specific in an area of Africa with high prevalence of HIV-infection. This can lead to the overuse of antituberculosis drugs, which are relatively expensive. False positive scores were found in children with HIV infection or severe malnourishment.
Specialty: Infectious Diseases, Pulmonology
ICD-10: ,
