A systematic review of clinical diagnostic systems used in the diagnosis of tuberculosis in children

Emily C. Pearce, Jason F. Woodward, Winstone M. Nyandiko, Rachel C. Vreeman, Samuel O. Ayaya

Research output: Contribution to journalArticle

26 Scopus citations


Background. Tuberculosis (TB) is difficult to diagnose in children due to lack of a gold standard, especially in resource-limited settings. Scoring systems and diagnostic criteria are often used to assist in diagnosis; however their validity, especially in areas with high HIV prevalence, remains unclear. Methods. We searched online bibliographic databases, including MEDLINE and EMBASE. We selected all studies involving scoring systems or diagnostic criteria used to aid in the diagnosis of tuberculosis in children and extracted data from these studies. Results. The search yielded 2261 titles, of which 40 met selection criteria. Eighteen studies used point-based scoring systems. Eighteen studies used diagnostic criteria. Validation of these scoring systems yielded varying sensitivities as gold standards used ranged widely. Four studies evaluated and compared multiple scoring criteria. Ten studies selected for pulmonary tuberculosis. Five studies specifically evaluated the use of scoring systems in HIV-positive children, generally finding the specificity to be lower. Conclusions. Though scoring systems and diagnostic criteria remain widely used in the diagnosis of tuberculosis in children, validation has been difficult due to lack of an established and accessible gold standard. Estimates of sensitivity and specificity vary widely, especially in populations with high HIV co-infection.

Original languageEnglish (US)
Article number401896
JournalAIDS Research and Treatment
StatePublished - Dec 1 2012


ASJC Scopus subject areas

  • Immunology and Allergy
  • Dermatology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Pearce, E. C., Woodward, J. F., Nyandiko, W. M., Vreeman, R. C., & Ayaya, S. O. (2012). A systematic review of clinical diagnostic systems used in the diagnosis of tuberculosis in children. AIDS Research and Treatment, 2012, [401896]. https://doi.org/10.1155/2012/401896