A El-Solh, J Mylotte, S Sherif, J Serghani and BJ Grant
Department of Medicine, State University of New York at Buffalo, 14215, USA.

The recent outbreaks of multidrug-resistant strains of M. tuberculosis in health care facilities has increased concern over its transmission in health care facilities. Isolation has been recommended for all patients suspected to have tuberculosis even though the feasibility and the cost of this recommendation can be substantial. We have developed a classification tree using clinical and radiographic data from 277 isolation episodes in patients admitted between August 1992 and March 1994 who required isolation for suspicion of tuberculosis. The classification tree was developed with a sensitivity and negative predictive value of 100% by binary recursive partitioning to predict those patients who are unlikely to require isolation. The predictor variables were upper zone disease on chest radiograph, a history of fever, weight loss, and CD4 count. The tree was validated in a separate cohort of 286 isolation episodes between April 1994 and December 1995. In this validation cohort, no erroneous prediction was made of not isolating a patient with active pulmonary tuberculosis. The classification tree had a sensitivity of 100% (95% confidence interval [CI]: 92.5 to 100%), a specificity of 48.1% (95% CI: 43.8 to 52.4%), and a negative predictive value of 100% (95% CI: 98.5 to 100%). We estimate that the use of the tree could have reduced the number of patients requiring isolation by more than 40% without increasing the risk of cross infection.

This article has been cited by other articles:

				T. Borlawsky and G. Hripcsak Evaluation of an Automated Pressure Ulcer Risk Assessment Model Home Health Care Management Practice, June 1, 2007; 19(4): 272 - 284. [Abstract] [PDF]

				J. P. Wisnivesky, C. Henschke, J. Balentine, C. Willner, A. M. Deloire, and T. G. McGinn Prospective Validation of a Prediction Model for Isolating Inpatients With Suspected Pulmonary Tuberculosis Arch Intern Med, February 28, 2005; 165(4): 453 - 457. [Abstract] [Full Text] [PDF]

				L. B. Gerald, S. Tang, F. Bruce, D. Redden, M. E. Kimerling, N. Brook, N. Dunlap, and W. C. Bailey A Decision Tree for Tuberculosis Contact Investigation Am. J. Respir. Crit. Care Med., October 15, 2002; 166(8): 1122 - 1127. [Abstract] [Full Text] [PDF]

				R. Long Smear-Negative Pulmonary Tuberculosis in Industrialized Countries Chest, August 1, 2001; 120(2): 330 - 334. [Full Text] [PDF]

				A. M. Kanaya, D. V. Glidden, and H. F. Chambers Identifying Pulmonary Tuberculosis in Patients With Negative Sputum Smear Results Chest, August 1, 2001; 120(2): 349 - 355. [Abstract] [Full Text] [PDF]

				R Freeman, J Magee, and A Barrett Identifying sputum specimens of high priority for examination by enhanced mycobacterial detection, identification, and susceptibility systems (EMDISS) to promote the rapid diagnosis of infectious pulmonary tuberculosis J. Clin. Pathol., August 1, 2001; 54(8): 613 - 616. [Abstract] [Full Text] [PDF]

				T. F. JONES and W. SCHAFFNER Miniature Chest Radiograph Screening for Tuberculosis in Jails . A Cost-effectiveness Analysis Am. J. Respir. Crit. Care Med., July 1, 2001; 164(1): 77 - 81. [Abstract] [Full Text] [PDF]

				J. P. Wisnivesky, J. Kaplan, C. Henschke, T. G. McGinn, and R. G. Crystal Evaluation of Clinical Parameters to Predict Mycobacterium tuberculosis in Inpatients Arch Intern Med, September 11, 2000; 160(16): 2471 - 2476. [Abstract] [Full Text]

				T. K. Lim, A. Gough, N.-K. Chin, and G. Kumarasinghe Relationship Between Estimated Pretest Probability and Accuracy of Automated Mycobacterium tuberculosis Assay in Smear-Negative Pulmonary Tuberculosis Chest, September 1, 2000; 118(3): 641 - 647. [Abstract] [Full Text] [PDF]

				A. Catanzaro, S. Perry, J. E. Clarridge, S. Dunbar, S. Goodnight-White, P. A. LoBue, C. Peter, G. E. Pfyffer, M. F. Sierra, R. Weber, et al. The Role of Clinical Suspicion in Evaluating a New Diagnostic Test for Active Tuberculosis: Results of a Multicenter Prospective Trial JAMA, February 2, 2000; 283(5): 639 - 645. [Abstract] [Full Text] [PDF]

				A. A. El-Solh, C.-B. Hsiao, S. Goodnough, J. Serghani, and B. J. B. Grant Predicting Active Pulmonary Tuberculosis Using an Artificial Neural Network Chest, October 1, 1999; 116(4): 968 - 973. [Abstract] [Full Text] [PDF]

				D. R. LEFF and A. R. LEFF Tuberculosis Control Policies in Major Metropolitan Health Departments in the United States . VI. Standard of Practice in 1996 Am. J. Respir. Crit. Care Med., November 1, 1997; 156(5): 1487 - 1494. [Abstract] [Full Text]