Evidence map›Paper›PMID 27964822›Full record

SynthesisThe Lancet. Infectious diseases2017

Mortality in children diagnosed with tuberculosis: a systematic review and meta-analysis.

Helen E Jenkins, Courtney M Yuen, Carly A Rodriguez, Ruvandhi R Nathavitharana, Megan M McLaughlin, Peter Donald, Ben J Marais, Mercedes C Becerra

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

Synthesis in The Lancet. Infectious diseases, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06239337 (Evaluation of Xpert MTB/RIF Ultra in Stools and Urine to Improve Tuberculosis Diagnosis in Children), which is not on this map. Cited by 143 papers, 17 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
143citing papers in PubMed, 17 pooled it
16.5field-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.

NCT06239337 completednot on this mapstarted 2019, after this paper: background citation

Evaluation of Xpert MTB/RIF Ultra in Stools and Urine to Improve Tuberculosis Diagnosis in Children

Typeobservational_patient_registrySponsorMedecins Sans Frontieres, SpainRan2019 to 2023Enrolled563ConditionsTuberculosis, Pediatric Infectious DiseaseArmsXpert MTB/RIF Ultra in stools and urine
3 · Its place in the literature

Who cites it

143 citing papers in PubMed, 17 syntheses or guidelines pooled it, 251 citations in OpenAlex.

  1. Pooled it
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  9. Screening tests for active pulmonary tuberculosis in children.The Cochrane database of systematic reviews · 2021
    Pooled it
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  13. Treatment of Drug-Resistant Tuberculosis. An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline.American journal of respiratory and critical care medicine · 2019
    Guideline
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  19. Clinical Outcomes in Children With Human Immunodeficiency Virus Treated for Nonsevere Tuberculosis in the SHINE Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024
    Trial
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83 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 7 institutions in 3 countries.

Helen E JenkinsDivision of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA. Electronic address: jenkins.helen@gmail.com.
Courtney M YuenDivision of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
Carly A RodriguezDepartment of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
Ruvandhi R NathavitharanaDivision of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Megan M McLaughlinDepartment of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
Peter DonaldDepartment of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Ben J MaraisThe Children's Hospital at Westmead, University of Sydney, Sydney, NSW, Australia.
Mercedes C BecerraDivision of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
Harvard Global Health Institute · USBeth Israel Deaconess Medical Center · USBoston University · USBrigham and Women's Hospital · USChildren's Hospital at Westmead · AUHarvard University · USWestern Cape Department of Health · ZA

Funding

Understanding spatial heterogeneity of drug resistant tuberculosisK01AI102944 · NIAID · BRIGHAM AND WOMEN'S HOSPITAL · PI JENKINS, HELEN E. · 2013 to 2017
$627k
NIAID NIH HHS K01 AI102944
6 · The paper itself

Abstract

backgroundCase fatality ratios in children with tuberculosis are poorly understood-particularly those among children with HIV and children not receiving tuberculosis treatment. We did a systematic review of published work to identify studies of population-representative samples of paediatric (ie, <15 years) tuberculosis cases.

methodsWe searched PubMed and Embase for reports published in English, French, Portuguese, or Spanish before Aug 12, 2016, that included terms related to tuberculosis, children, mortality, and population representativeness. We also reviewed our own files and reference lists of articles identified by this search. We screened titles and abstracts for inclusion, excluding studies in which outcomes were unknown for 10% or more of the children and publications detailing non-representative samples. We used random-effects meta-analysis to produce pooled estimates of case fatality ratios from the included studies, which we divided into three eras: the pre-treatment era (ie, studies before 1946), the middle era (1946-80), and the recent era (after 1980). We stratified our analyses by whether or not children received tuberculosis treatment, age (0-4 years, 5-14 years), and HIV status.

findingsWe identified 31 papers comprising 35 datasets representing 82 436 children with tuberculosis disease, of whom 9274 died. Among children with tuberculosis included in studies in the pre-treatment era, the pooled case fatality ratio was 21·9% (95% CI 18·1-26·4) overall. The pooled case fatality ratio was significantly higher in children aged 0-4 years (43·6%, 95% CI 36·8-50·6) than in those aged 5-14 years (14·9%, 11·5-19·1). In studies in the recent era, when most children had tuberculosis treatment, the pooled case fatality ratio was 0·9% (95% CI 0·5-1·6). US surveillance data suggest that the case fatality ratio is substantially higher in children with HIV receiving treatment for tuberculosis (especially without antiretroviral therapy) than in those without HIV.

interpretationWithout adequate treatment, children with tuberculosis, especially those younger than 5 years, are at high risk of death. Children with HIV have an increased mortality risk, even when receiving tuberculosis treatment.

fundingUS National Institutes of Health, Janssen Global Public Health.

Indexed as

AdolescentChildChild, PreschoolGlobal HealthHIV InfectionsHumansInfantInfant, NewbornTuberculosis

Identifiers

PMID27964822
PMCPMC5330933
OpenAlexW2560550631

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.