The Diagnostic Accuracy of Chest Radiographic Features for Pediatric Intrathoracic Tuberculosis

The chest radiograph (CR) remains a key tool in the diagnosis of pediatric tuberculosis (TB). In children with presumptive intrathoracic TB, we aimed to identify CR features that had high specificity for, and were strongly associated with, bacteriologically confirmed TB. We analyzed CR data from chi...

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Bibliographic Details
Published in:Clinical infectious diseases Vol. 75; no. 6; p. 1014
Main Authors: Palmer, Megan, Gunasekera, Kenneth S, van der Zalm, Marieke M, Morrison, Julie, Simon Schaaf, H, Goussard, Pierre, Hesseling, Anneke C, Walters, Elisabetta, Seddon, James A
Format: Journal Article
Language:English
Published: United States 29.09.2022
Subjects:
Child
Cohort Studies
Humans
Pleural Effusion
Radiography
Tuberculosis
Tuberculosis, Pulmonary - diagnostic imaging
radiograph
chest x-ray
children
tuberculosis
pediatric
ISSN:1537-6591, 1537-6591
Online Access:Get more information
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Summary:The chest radiograph (CR) remains a key tool in the diagnosis of pediatric tuberculosis (TB). In children with presumptive intrathoracic TB, we aimed to identify CR features that had high specificity for, and were strongly associated with, bacteriologically confirmed TB. We analyzed CR data from children with presumptive intrathoracic TB prospectively enrolled in a cohort study in a high-TB burden setting and who were classified using standard clinical case definitions as "confirmed," "unconfirmed," or "unlikely" TB. We report the CR features and inter-reader agreement between expert readers who interpreted the CRs. We calculated the sensitivity and specificity of the CR features with at least moderate inter-reader agreement and analyzed the relationship between these CR 
features and the classification of TB in a multivariable regression model. Of features with at least moderate inter-reader agreement, enlargement of perihilar and/or paratracheal lymph nodes, bronchial deviation/compression, cavities, expansile pneumonia, and pleural effusion had a specificity of > 90% for confirmed TB, compared with unlikely TB. Enlargement of perihilar (adjusted odds ratio [aOR]: 6.6; 95% confidence interval [CI], 3.80-11.72) and/or paratracheal lymph nodes (aOR: 5.14; 95% CI, 2.25-12.58), bronchial deviation/compression (aOR: 6.22; 95% CI, 2.70-15.69), pleural effusion (aOR: 2.27; 95% CI, 1.04-4.78), and cavities (aOR: 7.45; 95% CI, 3.38-17.45) were associated with confirmed TB in the multivariate regression model, whereas alveolar opacification (aOR: 1.16; 95% CI, .76-1.77) and expansile pneumonia (aOR: 4.16; 95% CI, .93-22.34) were not. In children investigated for intrathoracic TB enlargement of perihilar or paratracheal lymph nodes, bronchial compression/deviation, pleural effusion, or cavities on CR strongly support the diagnosis.
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ISSN:1537-6591
1537-6591
DOI:10.1093/cid/ciac011