Diagnostic accuracy of chest radiography in detecting mediastinal lymphadenopathy in suspected pulmonary tuberculosis.

Abstract:

OBJECTIVE:To estimate the diagnostic accuracy of chest radiography in the detection of chest lymphadenopathy in children with clinically suspected pulmonary tuberculosis. METHODS: DESIGN:Prospective cross sectional study. SETTING:A short stay ward in a children's hospital in South Africa. PATIENTS:Consecutive children under 14 years of age admitted with suspected pulmonary tuberculosis. DIAGNOSTIC TEST:Antero-posterior and/or lateral chest x rays interpreted independently and blind to the reference standard by three primary care clinicians and three paediatricians, all with a special interest in tuberculosis. Reference standard: Spiral chest computed tomography (CT) with contrast injection. RESULTS:One hundred children (median age 21.5 months) were enrolled. Lymphadenopathy was present in 46 of 100 reference CT scans and judged to be present in 47.1% of x ray assessments. Overall sensitivity was 67% and specificity 59%. Primary care clinicians were more sensitive (71.5% v 63.3%, p = 0.047) and less specific (49.8% v 68.9%, p<0.001) than paediatricians. Overall accuracy was higher for the paediatricians (diagnostic odds ratio 3.83 v 2.49, p = 0.008). The addition of a lateral to an antero-posterior view did not significantly increase accuracy (diagnostic odds ratio 3.09 v 3.73, p = 0.16). Chance adjusted inter-observer agreement (kappa) varied widely between viewer pairs, but was around 30%. CONCLUSIONS:Detection of mediastinal lymphadenopathy on chest x ray to diagnose pulmonary tuberculosis in children must be interpreted with caution. Diagnostic accuracy might be improved by refining radiological criteria for lymphadenopathy.

journal_name

Arch Dis Child

authors

Swingler GH,du Toit G,Andronikou S,van der Merwe L,Zar HJ

doi

10.1136/adc.2004.062315

subject

Has Abstract

pub_date

2005-11-01 00:00:00

pages

1153-6

issue

11

eissn

0003-9888

issn

1468-2044

pii

90/11/1153

journal_volume

90

pub_type

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