Applicability of scoring chart in the early detection of tuberculosis in children

Abstract

Objective: To test the applicability of scoring chart to detect children suffering from tuberculosis.

Design: Case control study.

Place and duration of study: The study was conducted at the Department of Paediatrics Unit-1, Civil Hospital, Karachi.

Subject and methods: Included in this study were 50 children in whom tuberculosis (TB) was diagnosed on the basis of history, physical signs, investigations and positive response to anti-tuberculous therapy. Also included in the study were 50 controls admitted with diagnosis other than tuberculosis. Modified Kenneth Jones Scoring Chart (KJSC) was applied to both the groups of children. These children were given a score of 0-7 or above according to the chart. The sensitivity of various parameters used in the KJSC was also tested in both the groups.

Results: A score of 1-2 (TB unlikely) was found in none of the cases versus 44% in the controls. Score of 5-6 (TB probable) was obtained in 40% of cases and none in the controls. Fifty-six percent cases had a score of 7 or more (TB unquestionable) versus 0% in controls. Contact with an adult suffering from tuberculosis, physical and radiological signs suggestive of tuberculosis and an exaggerated reaction to BCG vaccine emerged as the most important indicators used in the scoring chart to detect children with tuberculosis.

Conclusion: The Kenneth Jones Scoring Chart is a simple cost-effective tool, which can easily be applied to improve the case detection rate in children. In the absence of a gold standard for diagnosing tuberculosis in children and in view of logistic and financial constraints faced by resource constraint countries, like ours, this simple screening tool can be utilized at the health care facilities.