PRESUMPTIVE TUBERCULAR EMPYEMA THORACIS SCORING SYSTEM (pTESS) IN CHILDREN : AN OBSERVATIONAL RETROSPECTIVE COHORT STUDY.

Abstract

Introduction:

Global TB Report 2018 reports that in India, an estimated 2.2 lakh children become ill with tuberculosis (TB) each year (22% of the global TB burden), with a slightly higher burden among males. Pulmonary TB is the most common form in children but the extra-pulmonary TB forms a larger proportion of cases than in adults. Aim & Objective: To find out the diagnostic efficacy of the Scoring system in presumptive tubercular empyema thoracis and the diagnostic accuracy of CBNAAT in the diagnosis of tubercular empyema thoracis.

Material & Method:

41 patients aged 1-14 years were enrolled after written informed consent was obtained from the patients. Children with ATT or preexisting lung disease were excluded from the study. Presumptive TB Empyema was defined on the basis of the revised National Tuberculosis Program (RNTCP). The cutoff score for the scoring system was calculated and retrospectively applied to the 41 subjects and the efficacy was assessed.

RESULT:

pTESS had an area under the curve 0.967(95% CI 0.902-1.000, p-value <0.001)Indicating a good predictive value in predicting tubercular empyema had a sensitivity of 90.91% (58.72% to 99.77%) and specificity 96.67 %( 82.78%- 99.2%), false positive rate 3.33%( 0.08%- 17.22% ), false negative rate 9.09%(23%- 41.28%) positive predictive value 90.91% (58.72%- 99.77%), negative predictive value 96.67% (82.78%- 99.92%), LR+=27.27 LR-=0.09OR-130.5, Youden Index 0.8. The sensitivity of CBNAAT in our study was 36.36% and specificity of 96.67% positive predictive value of 80%, negative predictive value of 80.56%.

Conclusion:

pTESS  Scoring System can be used for the diagnosis of TB Empyema.

Recommendation:

Clinical assessment by the pTESS scoring system may be used for diagnosis of TB Empyema in the pediatric age group.