Efetividade do escore clínico neural TB no diagnóstico rápido da tuberculose pulmonar em serviço de referência

Abstract

Objectives: Mainly in regions with the greatest TB burden in the world, there is still a delay for patients to receive the results of the diagnostic exams. Researchers from Rede Brasileira de Tuberculose developed and evaluated the performance of a diagnostic test for pulmonary TB: Neural TB clinical score. The objective of the present work is to evaluate the effectiveness of the Neural TB clinical score in the rapid diagnose of pulmonary tuberculosis in a reference unit. Methods: A pragmatic clinical essay with diagnostic intervention in the second half of the project was conducted. We recruited 351 patients aged 18 years or older, suspected of having pulmonary TB, and we applied the Neural TB clinical score to them. In the first phase of the essay, patients followed the routine of the Hospital. In the second phase, patients had collection of sputum samples for baciloscopy anticipated according to their classification by the score. T-Student test and Mann Whitney test were used to compare two independent subpopulations. Results were considered significant if p value < 0,05. Prevalence ratio and 95% confidence interval were calculated. Kappa index was used to measure conformity between the clinical score and pulmorary TB diagnostic. Results: Neural TB clinical score showed sensitivity of 75,9%, specificity of 48,8% and accuracy of 55% when compared to the diagnostic realised through sputum baciloscopy, sputum culture or clinical-radiological diagnostic altogether. The use of Neural TB clinical score was able to reduce time between patient screening and detection of organisms in a sputum sample slide in 1 day (from 3.2 to 2.6 days; p < 0.001). Although time until beginning the treatment was reduced 4 days in average when compared to the baseline group (from 8.2 to 4 days), this difference was not statistically significant (p = 0.166). Conclusion: The clinical score may be a useful tool for the detection of pulmonary tuberculosis cases. Because it is simple, it does not require expensive or complex equipment for its execution. As it is used by a trained professional, the questionnaire may produce information about referrals or test requests for the respiratory symptomatic patient, or even help in the decision of starting treatment.