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AIDS Res Treat. 2012; 2012: 401896.
Published online Jul 17, 2012. doi:  10.1155/2012/401896
PMCID: PMC3405645
A Systematic Review of Clinical Diagnostic Systems Used in the Diagnosis of Tuberculosis in Children
Emily C. Pearce, 1 * Jason F. Woodward, 1 Winstone M. Nyandiko, 2 Rachel C. Vreeman, 1 and Samuel O. Ayaya 2
1Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
2Department of Pediatrics, Moi University School of Medicine, Eldoret 30100, Kenya
*Emily C. Pearce: ecpearce/at/gmail.com
Academic Editor: Amneris Luque
Received March 28, 2012; Accepted May 9, 2012.
Abstract
Background. Tuberculosis (TB) is difficult to diagnose in children due to lack of a gold standard, especially in resource-limited settings. Scoring systems and diagnostic criteria are often used to assist in diagnosis; however their validity, especially in areas with high HIV prevalence, remains unclear. Methods. We searched online bibliographic databases, including MEDLINE and EMBASE. We selected all studies involving scoring systems or diagnostic criteria used to aid in the diagnosis of tuberculosis in children and extracted data from these studies. Results. The search yielded 2261 titles, of which 40 met selection criteria. Eighteen studies used point-based scoring systems. Eighteen studies used diagnostic criteria. Validation of these scoring systems yielded varying sensitivities as gold standards used ranged widely. Four studies evaluated and compared multiple scoring criteria. Ten studies selected for pulmonary tuberculosis. Five studies specifically evaluated the use of scoring systems in HIV-positive children, generally finding the specificity to be lower. Conclusions. Though scoring systems and diagnostic criteria remain widely used in the diagnosis of tuberculosis in children, validation has been difficult due to lack of an established and accessible gold standard. Estimates of sensitivity and specificity vary widely, especially in populations with high HIV co-infection.
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