McNally, G;
Solomon, D;
Brown, M;
Capocci, S;
Creer, D;
Dekoningh, J;
Lozewicz, S;
... Brown, J; + view all
(2025)
A diagnostic certainty score to support improvements in culture confirmation of TB.
International Journal of Tuberculosis and Lung Disease
, 29
(5)
pp. 227-230.
10.5588/ijtld.24.0418.
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Abstract
Improving the diagnostic confirmation of active TB disease is a key objective of the England & Wales TB Action Plan. However, national data suggest little change in the proportion of TB cases confirmed by positive culture in recent years, with 61% of all cases and 74% of pulmonary TB cases confirmed by culture. We report the introduction of a simple tool that records the diagnostic certainty of tuberculosis during cohort review of new TB cases diagnosed within our TB network in an attempt to improve culture confirmation rates. In North-Central London TB service, we developed a diagnostic certainty score, using results of mycobacterial cultures, molecular diagnostics, microscopy, histology, clinical and radiology results, to grade cases on a 1–5 scale. Since 2017, this has been routinely used as part of our quarterly patient Cohort Reviews. We evaluated the relationship between its introduction and TB culture confirmation. There was a significant improvement in culture confirmation rates from 59% in 2017 to 75% in 2022. By 2022, 86% of pulmonary TB cases were confirmed by TB culture and 55% of extrapulmonary cases. A simple diagnostic certainty score was associated with improved diagnostic confirmation of TB disease and may be helpful for other TB services and TB programmes.
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