دورية أكاديمية
Development of treatment-decision algorithms for children evaluated for pulmonary tuberculosis: an individual participant data meta-analysis.
| العنوان: | Development of treatment-decision algorithms for children evaluated for pulmonary tuberculosis: an individual participant data meta-analysis. |
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| المؤلفون: | Gunasekera KS; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA. Electronic address: kenneth.gunasekera@yale.edu., Marcy O; Inserm UMR1219, Institut de Recherche pour le Développement EMR 271, GHiGS, University of Bordeaux, Bordeaux, France., Muñoz J; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands., Lopez-Varela E; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa., Sekadde MP; National Tuberculosis and Leprosy Program, Kampala, Uganda., Franke MF; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA., Bonnet M; University of Montpellier, TransVIHMI, Institut de Recherche pour le Développement, Inserm, Montpellier, France; Epicentre, Mbarara, Uganda., Ahmed S; Department of Paediatrics, Dhaka Medical College Hospital, Dhaka, Bangladesh., Amanullah F; Indus Hospital & Health Network, Karachi, Pakistan; The Aga Khan University Hospital, Karachi, Pakistan., Anwar A; Indus Hospital & Health Network, Karachi, Pakistan., Augusto O; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique., Aurilio RB; Instituto de Puericultura e Pediatria Martagao Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil., Banu S; Programme on Emerging Infections, Infectious Disease Division, icddr,b, Dhaka, Bangladesh., Batool I; Indus Hospital & Health Network, Karachi, Pakistan., Brands A; Global Tuberculosis Programme, WHO, Geneva, Switzerland., Cain KP; US Centers for Disease Control and Prevention, Atlanta, GA, USA., Carratalá-Castro L; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique., Caws M; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Birat Nepal Medical Trust, Lazmipat, Kathmandu, Nepal., Click ES; US Centers for Disease Control and Prevention, Atlanta, GA, USA., Cranmer LM; Department of Pediatrics, Emory School of Medicine, Atlanta, GA, USA; Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA., García-Basteiro AL; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Barcelona, Spain., Hesseling AC; Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa., Huynh J; Oxford University Clinical Research Unit, Centre for Tropical Diseases, Ho Chi Minh City, Viet Nam; Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK., Kabir S; Programme on Emerging Infections, Infectious Disease Division, icddr,b, Dhaka, Bangladesh., Lecca L; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Socios En Salud Surcursal Perú, Lima, Perú., Mandalakas A; Global TB Program, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA; Clinical Infectious Disease Group, German Center for Infectious Research, Clinical TB Unit, Research Center Borstel, Borstel, Germany., Mavhunga F; Global Tuberculosis Programme, WHO, Geneva, Switzerland., Myint AA; Department of Paediatrics, University of Medicine, Mandalay, Myanmar., Myo K; Department of Paediatrics, University of Medicine, Magway, Myanmar., Nampijja D; Department of Paediatrics, Mbarara University of Science and Technology, Mbarara, Uganda., Nicol MP; Division of Infection and Immunity, Department of Biomedical Sciences, University of Western Australia, Perth, WA, Australia., Orikiriza P; Epicentre, Mbarara, Uganda; Department of Microbiology, Division of Basic Medical Sciences, School of Medicine, University of Global Health Equity, Kigali, Rwanda., Palmer M; Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa., Sant'Anna CC; Faculty of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil., Siddiqui SA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Indus Hospital & Health Network, Karachi, Pakistan., Smith JP; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA; US Centers for Disease Control and Prevention, Atlanta, GA, USA., Song R; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK., Thuong Thuong NT; Oxford University Clinical Research Unit, Centre for Tropical Diseases, Ho Chi Minh City, Viet Nam; Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK., Ung V; University of Health Sciences, Phnom Penh, Cambodia; National Pediatric Hospital, Phnom Penh, Cambodia., van der Zalm MM; Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa., Verkuijl S; Global Tuberculosis Programme, WHO, Geneva, Switzerland., Viney K; Global Tuberculosis Programme, WHO, Geneva, Switzerland; School of Public Health, University of Sydney, Sydney, NSW, Australia., Walters EG; Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; Directorate of Integrated Laboratory Medicine, Institute of Human Genetics, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK., Warren JL; Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA., Zar HJ; Department of Paediatrics and Child Health, Red Cross Children's Hospital, and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa., Marais BJ; The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia., Graham SM; Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, VIC, Australia; Burnet Institute, Melbourne, VIC, Australia., Debray TPA; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands., Cohen T; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA., Seddon JA; Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; Department of Infectious Diseases, Imperial College London, London, UK. |
| المصدر: | The Lancet. Child & adolescent health [Lancet Child Adolesc Health] 2023 May; Vol. 7 (5), pp. 336-346. Date of Electronic Publication: 2023 Mar 13. |
| نوع المنشور: | Meta-Analysis; Journal Article; Research Support, U.S. Gov't, P.H.S.; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Ltd Country of Publication: England NLM ID: 101712925 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2352-4650 (Electronic) Linking ISSN: 23524642 NLM ISO Abbreviation: Lancet Child Adolesc Health Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: [Cambridge, UK] : Elsevier Ltd., [2017]- |
| مواضيع طبية MeSH: | Tuberculosis, Pulmonary*/diagnosis , Tuberculosis, Pulmonary*/drug therapy , Tuberculosis, Pulmonary*/epidemiology , Tuberculosis*, United States ; Adolescent ; Humans ; Child ; Retrospective Studies ; Triage ; Algorithms |
| مستخلص: | Background: Many children with pulmonary tuberculosis remain undiagnosed and untreated with related high morbidity and mortality. Recent advances in childhood tuberculosis algorithm development have incorporated prediction modelling, but studies so far have been small and localised, with limited generalisability. We aimed to evaluate the performance of currently used diagnostic algorithms and to use prediction modelling to develop evidence-based algorithms to assist in tuberculosis treatment decision making for children presenting to primary health-care centres. Methods: For this meta-analysis, we identified individual participant data from a WHO public call for data on the management of tuberculosis in children and adolescents and referral from childhood tuberculosis experts. We included studies that prospectively recruited consecutive participants younger than 10 years attending health-care centres in countries with a high tuberculosis incidence for clinical evaluation of pulmonary tuberculosis. We collated individual participant data including clinical, bacteriological, and radiological information and a standardised reference classification of pulmonary tuberculosis. Using this dataset, we first retrospectively evaluated the performance of several existing treatment-decision algorithms. We then used the data to develop two multivariable prediction models that included features used in clinical evaluation of pulmonary tuberculosis-one with chest x-ray features and one without-and we investigated each model's generalisability using internal-external cross-validation. The parameter coefficient estimates of the two models were scaled into two scoring systems to classify tuberculosis with a prespecified sensitivity target. The two scoring systems were used to develop two pragmatic, treatment-decision algorithms for use in primary health-care settings. Findings: Of 4718 children from 13 studies from 12 countries, 1811 (38·4%) were classified as having pulmonary tuberculosis: 541 (29·9%) bacteriologically confirmed and 1270 (70·1%) unconfirmed. Existing treatment-decision algorithms had highly variable diagnostic performance. The scoring system derived from the prediction model that included clinical features and features from chest x-ray had a combined sensitivity of 0·86 [95% CI 0·68-0·94] and specificity of 0·37 [0·15-0·66] against a composite reference standard. The scoring system derived from the model that included only clinical features had a combined sensitivity of 0·84 [95% CI 0·66-0·93] and specificity of 0·30 [0·13-0·56] against a composite reference standard. The scoring system from each model was placed after triage steps, including assessment of illness acuity and risk of poor tuberculosis-related outcomes, to develop treatment-decision algorithms. Interpretation: We adopted an evidence-based approach to develop pragmatic algorithms to guide tuberculosis treatment decisions in children, irrespective of the resources locally available. This approach will empower health workers in primary health-care settings with high tuberculosis incidence and limited resources to initiate tuberculosis treatment in children to improve access to care and reduce tuberculosis-related mortality. These algorithms have been included in the operational handbook accompanying the latest WHO guidelines on the management of tuberculosis in children and adolescents. Future prospective evaluation of algorithms, including those developed in this work, is necessary to investigate clinical performance. Funding: WHO, US National Institutes of Health. Competing Interests: Declaration of interests We declare no competing interests. (© 2023 World Health Organization. Published by Elsevier Ltd. All rights reserved. This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.) |
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| معلومات مُعتمدة: | T32 GM007205 United States GM NIGMS NIH HHS; K23 HD072802 United States HD NICHD NIH HHS; R01 HD058971 United States HD NICHD NIH HHS; R01 AI137093 United States AI NIAID NIH HHS; MR/R007942/1 United Kingdom MRC_ Medical Research Council; UL1 TR001863 United States TR NCATS NIH HHS; R01 AI147854 United States AI NIAID NIH HHS; F30 HD105440 United States HD NICHD NIH HHS; K23 AI143479 United States AI NIAID NIH HHS; United States PEPFAR PEPFAR; K43 TW011028 United States TW FIC NIH HHS; 001 International WHO_ World Health Organization |
| تواريخ الأحداث: | Date Created: 20230316 Date Completed: 20230421 Latest Revision: 20240307 |
| رمز التحديث: | 20240307 |
| مُعرف محوري في PubMed: | PMC10127218 |
| DOI: | 10.1016/S2352-4642(23)00004-4 |
| PMID: | 36924781 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 2352-4650 |
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| DOI: | 10.1016/S2352-4642(23)00004-4 |