Redd and Susser developed a simple score for identifying a patient in an urban Emergency Department who may need to be placed in isolation to prevent transmission of tuberculosis. The authors are from Columbia University and the New York State Psychiatric Institute.
Patient selection: urban Emergency Department
Parameters:
(1) chest X-ray
(2) temperature
(3) history of tuberculosis (positive skin test, exposure to tuberculosis, active tuberculosis)
(4) living status
Parameter
Finding
Points
chest X-ray
normal
0
abnormal
1
temperature
<= 101°F
0
> 101°F
1
history of tuberculosis
no
0
yes
1
living status
homeless shelter
1
other
0
where:
• Living status could be expanded to other high-risk groups.
• The abnormal chest X-ray could be made more specific.
risk score =
= SUM(points for the 4 risk factors)
Interpretation:
• minimum score: 0
• maximum score: 4
• A score >=2 indicates a patient who should be placed in isolation.
Performance:
• The sensitivity was 96% while the specificity was 54%.
• The positive predictive value is 10% and negative predictive value 100%.
• The prevalence of tuberculosis in the community would affect performance.
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