Evidence map›Paper›PMID 25812968›Full record

SynthesisThe Lancet. Respiratory medicine2015

Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis in children: a systematic review and meta-analysis.

Anne K Detjen, Andrew R DiNardo, Jacinta Leyden, Karen R Steingart, Dick Menzies, Ian Schiller, Nandini Dendukuri, Anna M Mandalakas

Registry-linked trialOpen access · greenAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The Lancet. Respiratory medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03356925 (Feasibility, Accuracy, and Effect of Point-of-care Xpert MTB/RIF Ultra and Xpert MTB/RIF Ultra Testing in Patients Suspected of Having TB), which is not on this map. Cited by 180 papers, 18 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
180citing papers in PubMed, 18 pooled it
19.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03356925 nacompletednot on this mapstarted 2018, after this paper: background citation

Feasibility, Accuracy, and Effect of Point-of-care Xpert MTB/RIF Ultra and Xpert MTB/RIF Ultra Testing in Patients Suspected of Having TB: a Randomised Controlled Trial

TypeinterventionalSponsorUniversity of StellenboschRan2018 to 2022Enrolled1,549ConditionsTuberculosisArmsXpert Ultra Point of Care testing
3 · Its place in the literature

Who cites it

180 citing papers in PubMed, 18 syntheses or guidelines pooled it, 321 citations in OpenAlex.

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  18. Diagnostic accuracy of nucleic acid amplification tests in urine for pulmonary tuberculosis: a meta-analysis.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2015
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  20. MPT64 patch test for the diagnosis of active pulmonary tuberculosis: a randomised controlled trial in Peru.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2018
    Trial

120 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 2 countries.

Anne K DetjenThe International Union Against Tuberculosis And Lung Disease (The Union), New York, NY, USA. Electronic address: adetjen@theunion.org.
Andrew R DiNardoInfectious Diseases, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA; The Global Tuberculosis Program, Texas Children's Hospital, Houston, TX, USA.
Jacinta LeydenDepartment of Bioengineering, Rice University, Houston, TX, USA; The Global Tuberculosis Program, Texas Children's Hospital, Houston, TX, USA.
Karen R SteingartCochrane Infectious Diseases Group, Liverpool School of Tropical Medicine, Liverpool, UK.
Dick MenziesRespiratory and Epidemiology Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, QC, Canada.
Ian SchillerDivision of Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada.
Nandini DendukuriDivision of Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada.
Anna M MandalakasThe Global Tuberculosis Program, Texas Children's Hospital, Houston, TX, USA; Retrovirology and Global Health, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
McGill University Health Centre · CALiverpool School of Tropical Medicine · GBMcGill University · CA

Funding

Research Training in Infections and ImmunityT32AI055413 · NIAID · BAYLOR COLLEGE OF MEDICINE · PI GIORDANO, THOMAS P, MYSOREKAR, INDIRA U · 2003 to 2024
$3.2M
NIAID NIH HHS T32 AI055413
6 · The paper itself

Abstract

backgroundMicrobiological confirmation of childhood tuberculosis is rare because of the difficulty of collection of specimens, low sensitivity of smear microscopy, and poor access to culture. We aimed to establish summary estimates for sensitivity and specificity of of the Xpert MTB/RIF assay compared with microscopy in the diagnosis of pulmonary tuberculosis in children.

methodsWe searched for studies published up to Jan 6, 2015, that used Xpert in any setting in children with and without HIV infection. We systematically reviewed studies that compared the diagnostic accuracy of Xpert MTB/RIF (Xpert) with microscopy for detection of pulmonary tuberculosis and rifampicin resistance in children younger than 16 years against two reference standards-culture results and culture-negative children who were started on anti-tuberculosis therapy. We did meta-analyses using a bivariate random-effects model.

findingsWe identified 15 studies including 4768 respiratory specimens in 3640 children investigated for pulmonary tuberculosis. Culture tests were positive for tuberculosis in 12% (420 of 3640) of all children assessed and Xpert was positive in 11% (406 of 3640). Compared with culture, the pooled sensitivities and specificities of Xpert for tuberculosis detection were 62% (95% credible interval 51-73) and 98% (97-99), respectively, with use of expectorated or induced sputum samples and 66% (51-81) and 98% (96-99), respectively, with use of samples from gastric lavage. Xpert sensitivity was 36-44% higher than was sensitivity for microscopy. Xpert sensitivity in culture-negative children started on antituberculosis therapy was 2% (1-3) for expectorated or induced sputum. Xpert's pooled sensitivity and specificity to detect rifampicin resistance was 86% (95% credible interval 53-98) and 98% (94-100), respectively.

interpretationCompared with microscopy, Xpert offers better sensitivity for the diagnosis of pulmonary tuberculosis in children and its scale-up will improve access to tuberculosis diagnostics for children. Although Xpert helps to provide rapid confirmation of disease, its sensitivity remains suboptimum compared with culture tests. A negative Xpert result does not rule out tuberculosis. Good clinical acumen is still needed to decide when to start antituberculosis therapy and continued research for better diagnostics is crucial.

fundingWHO, Global TB Program of Texas Children's Hospital.

Indexed as

AdolescentChildChild, PreschoolHumansInfantMolecular Diagnostic TechniquesReproducibility of ResultsSensitivity and SpecificityTuberculosis, Pulmonary

Identifiers

PMID25812968
PMCPMC4756280
OpenAlexW2157429822

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.