ArticlePloS one2013
Development of a simple reliable radiographic scoring system to aid the diagnosis of pulmonary tuberculosis.
Article in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 1 of them a synthesis that pooled it.
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Who cites it
26 citing papers in PubMed, 1 synthesis or guideline pooled it, 47 citations in OpenAlex.
- Chest X-ray Analysis With Deep Learning-Based Software as a Triage Test for Pulmonary Tuberculosis: An Individual Patient Data Meta-Analysis of Diagnostic Accuracy.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2022Pooled it
- Trial
- Performance of Human and Computer-aided Evaluation of Digital Chest Radiography for Community-based Screening of Asymptomatic Tuberculosis.medRxiv : the preprint server for health sciences · 2026Article
- Comparison of chest radiograph findings in ambulatory and hospitalized children with pulmonary tuberculosis.Pediatric radiology · 2023Article
- Article
- Development and Validation of the Tuberculosis Risk Score for Smokers (TBRSS).International journal of environmental research and public health · 2022Article
- High-resolution computed tomography features associated with differentiation of tuberculosis among elderly patients with community-acquired pneumonia: a multi-institutional propensity-score matched study.Scientific reports · 2022Article
- Predictors of tuberculosis disease in smokers: a case-control study in northeastern Malaysia.PeerJ · 2022Article
- Screening of Long Non-coding RNAs Biomarkers for the Diagnosis of Tuberculosis and Preliminary Construction of a Clinical Diagnosis Model.Frontiers in microbiology · 2022Article
- Chest x-ray findings in tuberculosis patients identified by passive and active case finding: A retrospective study.Journal of clinical tuberculosis and other mycobacterial diseases · 2019Article
- Pretreatment chest x-ray severity and its relation to bacterial burden in smear positive pulmonary tuberculosis.BMC medicine · 2018Article
- Accuracy of an automated system for tuberculosis detection on chest radiographs in high-risk screening.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2018Article
- False-Positive Xpert MTB/RIF Results in Retested Patients with Previous Tuberculosis: Frequency, Profile, and Prospective Clinical Outcomes.Journal of clinical microbiology · 2018Article
- Article
- Yield of chest X-ray tuberculosis screening of immigrants during the European refugee crisis of 2015: a single-centre experience.European radiology · 2017Article
- Diagnostic Outcomes After Chest Radiograph Interpretation in Patients With Suspected Tuberculosis and Negative Sputum Smears in a High-Burden Human Immunodeficiency Virus and Tuberculosis Setting.Open forum infectious diseases · 2017Article
- Chest radiograph reading and recording system: evaluation in frontline clinicians in Zambia.BMC infectious diseases · 2016Article
- Use of Standardized Uptake Value Ratios Decreases Interreader Variability of [18F] Florbetapir PET Brain Scan Interpretation.AJNR. American journal of neuroradiology · 2015Article
- Incidence of occupational latent tuberculosis infection in South African healthcare workers.The European respiratory journal · 2015Article
- Special computer-aided computed tomography (CT) volume measurement and comparison method for pulmonary tuberculosis (TB).International journal of clinical and experimental medicine · 2015Article
Corrections and comments
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Authors and funding
12 authors at 4 institutions in 2 countries.
Funding
Abstract
rationaleChest radiography is sometimes the only method available for investigating patients with possible pulmonary tuberculosis (PTB) with negative sputum smears. However, interpretation of chest radiographs in this context lacks specificity for PTB, is subjective and is neither standardized nor reproducible. Efforts to improve the interpretation of chest radiography are warranted.
objectivesTo develop a scoring system to aid the diagnosis of PTB, using features recorded with the Chest Radiograph Reading and Recording System (CRRS).
methodsChest radiographs of outpatients with possible PTB, recruited over 3 years at clinics in South Africa were read by two independent readers using the CRRS method. Multivariate analysis was used to identify features significantly associated with culture-positive PTB. These were weighted and used to generate a score.
results473 patients were included in the analysis. Large upper lobe opacities, cavities, unilateral pleural effusion and adenopathy were significantly associated with PTB, had high inter-reader reliability, and received 2, 2, 1 and 2 points, respectively in the final score. Using a cut-off of 2, scores below this threshold had a high negative predictive value (91.5%, 95%CI 87.1,94.7), but low positive predictive value (49.4%, 95%CI 42.9,55.9). Among the 382 TB suspects with negative sputum smears, 229 patients had scores <2; the score correctly ruled out active PTB in 214 of these patients (NPV 93.4%; 95%CI 89.4,96.3). The score had a suboptimal negative predictive value in HIV-infected patients (NPV 86.4, 95% CI 75,94).
conclusionsThe proposed scoring system is simple, and reliably ruled out active PTB in smear-negative HIV-uninfected patients, thus potentially reducing the need for further tests in high burden settings. Validation studies are now required.
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