Value of new modification of tuberculosis score in diagnosis of childhood pulmonary tuberculosis

Abstract

The difficulties in making an exact diagnosis of pulmonary tuberculosis in children have led to the development of different approaches for diagnosis. The aim of this study was to compare the validity of Edwards' score and a new modified Edwards' score in the diagnosis of childhood pulmonary tuberculosis. A cross sectional study was carried out at Al Azher University hospitals. One hundred twenty children were enrolled in the study and were divided to two groups. Tuberculosis group included 60 children with positive pathozyme TB complex test and respiratory symptoms and/or chest-X-ray (CXR) findings that improved using exclusively anti-tuberculosis drugs. Control group included 60 children with significant respiratory symptoms in the form of cough and or difficult breathing or tachypnea of duration not less than 7 days with or without CXR findings and who recovered from their symptoms and/or CXR findings using treatment other than anti-tuberculosis drugs and demonstrated negative pathozyme TB complex test. At enrolment the following investigations were performed: tuberculin skin test (TST), CXR postro-anterior view, complete blood count, ESR and pathozyme TB comp1ex plus test. Edwards' score and a new modified score were applied separately to all enrolled children. Sensitivity and specificity for diagnosis of pulmonary tuberculosis were higher for new modified Edwards' score than Edwards' score (93.3%, 95% versus 86.7%, 88.30% respectively). Also, positive and negative predictive values were higher for new modified Edwards' score compared with Edwards' score (95.9%, 93.4% versus 88.1%, 86.9% respectively). The mean score for diagnosis of pulmonary tuberculosis was higher in new modified Edwards' score than Edwards' score (11.4 ± 0.5 versus 10.3 ± 0.4 respectively). There was agreement between Edward score and new modified Edwards' score in diagnosis of 52 cases as pulmonary tuberculosis. It was concluded that new modified Edwards' score is better than Edwards' score in the diagnosis of childhood pulmonary tuberculosis. It was recommended to conduct a community based study with large sample size to evaluate the validity of new modified score when used on the large scale.