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. 2023 Apr 1;151(4):e2022059189.
doi: 10.1542/peds.2022-059189.

Number Needed to Screen for Tuberculosis Disease Among Children: A Systematic Review

Katherine O Robsky  1 , Lelia H Chaisson  2 , Fahd Naufal  3 , Pamela Delgado-Barroso  4 , Hector S Alvarez-Manzo  5 , Jonathan E Golub  1   3   6 , Adrienne E Shapiro  7 , Nicole Salazar-Austin  8
Affiliations

Number Needed to Screen for Tuberculosis Disease Among Children: A Systematic Review

Katherine O Robsky et al. Pediatrics. .

Abstract

Context: Improving detection of pediatric tuberculosis (TB) is critical to reducing morbidity and mortality among children.

Objective: We conducted a systematic review to estimate the number of children needed to screen (NNS) to detect a single case of active TB using different active case finding (ACF) screening approaches and across different settings.

Data sources: We searched 4 databases (PubMed, Embase, Scopus, and the Cochrane Library) for articles published from November 2010 to February 2020.

Study selection: We included studies of TB ACF in children using symptom-based screening, clinical indicators, chest x-ray, and Xpert.

Data extraction: We indirectly estimated the weighted mean NNS for a given modality, location, and population using the inverse of the weighted prevalence. We assessed risk of bias using a modified AXIS tool.

Results: We screened 27 221 titles and abstracts, of which we included 31 studies of ACF in children < 15 years old. Symptom-based screening was the most common screening modality (weighted mean NNS: 257 [range, 5-undefined], 19 studies). The weighted mean NNS was lower in both inpatient (216 [18-241]) and outpatient (67 [5-undefined]) settings (107 [5-undefined]) compared with community (1117 [28-5146]) and school settings (464 [118-665]). Risk of bias was low.

Limitations: Heterogeneity in the screening modalities and populations make it difficult to draw conclusions.

Conclusions: We identified a potential opportunity to increase TB detection by screening children presenting in health care settings. Pediatric TB case finding interventions should incorporate evidence-based interventions and local contextual information in an effort to detect as many children with TB as possible.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES: Dr Shapiro received grant funding to her institution from Vir Biotechnology, Inc., unrelated to this study. The other authors have indicated they have no potential conflicts of interest to disclose. The National Institutes of Health had no role in the design and conduct of the study. This analysis was part of a larger systematic review conducted on behalf of the World Health Organization (WHO) Guidelines Development Group on systematic screening for tuberculosis. The WHO had no role in the design and conduct of this specific analysis.

Figures

FIGURE 1
FIGURE 1
Study definitions for screening strategies and confirmation of active TB.
FIGURE 2
FIGURE 2
Study review and exclusion process.
FIGURE 3
FIGURE 3
Weighted mean number of children (<15 years of age) needed to screen to detect 1 TB diagnosis in countries with medium/high TB incidence, by screening modality.
See this image and copyright information in PMC

Comment in

References

    1. World Health Organization . Global tuberculosis report 2020. Available at: https://www.who.int/publications/i/item/9789240013131. Accessed November 29, 2022
    1. Dodd PJ, Gardiner E, Coghlan R, Seddon JA. Burden of childhood tuberculosis in 22 high-burden countries: a mathematical modelling study. Lancet Glob Health. 2014;2(8):e453–e459 - PubMed
    1. Jenkins HE, Yuen CM, Rodriguez CA, et al. Mortality in children diagnosed with tuberculosis: a systematic review and meta-analysis. Lancet Infect Dis. 2017;17(3):285–295 - PMC - PubMed
    1. Systematic screening for active tuberculosis: principles and recommendations. Geneva, Switzerland: World Health Organization; 2013 - PubMed
    1. Golub JE, Mohan CI, Comstock GW, Chaisson RE. Active case finding of tuberculosis: historical perspective and future prospects. Int J Tuberc Lung Dis. 2005;9(11):1183–1203 - PMC - PubMed

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