Scoring System of the Brazilian Ministry of Health for Diagnosis of Pulmonary Tuberculosis in Children

The Brazilian Ministry of Health uses a score for the diagnosis of tuberculosis in pediatric patients.

Parameters:

(1) clinical manifestations

(2) thoracic X-ray findings

(3) contact with an adult with tuberculosis

(4) history of BCG vaccination and results of tuberculin test

(5) nutritional status

Parameter	Finding	Points
clinical manifestations	improving with or without antibiotics for common bacteria	-10
	no symptoms or symptoms for < 2 weeks	0
	symptoms for > 2 weeks	+15
thoracic X-ray changes	normal	-5
	exudates or patch shadow with or without cavitation < 2 weeks or improving with antibiotics for common bacteria	+5
	exudates or patch shadow with or without cavitation > 2 weeks or unchanged/progressing despite antibiotics for common bacteria	+15
	enlarged hilum or military pattern	+15
contact with adult with TB	none or occasional	0
	close during past 2 years	+10
BCG and tuberculin	tuberculin <= 5 mm	0
	tuberculin 5.1 to 9 mm	+5
	tuberculin >= 10 mm without BCG	+15
	tuberculin >= 10 mm with BCG done >= 2 years ago	+15
	tuberculin >= 15 mm with BCG done < 2 years	+15
malnutrition	none	0
	mild to moderate	0
	severe	+5

where:

• Symptoms: fever or cough, loss of energy, sputum production, weight loss, night sweats.

• The table shows a gap for BCG < 2 years ago with tuberculin reaction 10 to 15 mm. In the implementation this will be assigned 5 points.

• The system does not incorporate HIV status.

total score =

= SUM(points for all 5 parameters)

Interpretation:

• minimum score: -15

• maximum score: 60 (assuming that only 1 score is given for each parameter)

• The higher the score the more likely the patient has pulmonary tuberculosis.

where:

• The smallest increment in the score is 5 points, so the total score is not continuous.

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