Sputum scarcity among adolescents and adults with presumptive tuberculosis: a systematic review and meta-analysis
Notice bibliographique
Résumé
Summary Background The diagnosis of tuberculosis (TB) typically relies on being able to produce a sputum sample for microbiological testing. However, sputum scarcity, the inability to self-expectorate an adequate sputum sample for TB testing, is a well-known concern. Our systematic review and meta-analysis investigated the proportion of sputum scarcity among adolescents and adults being evaluated for presumptive TB in healthcare facilities. Methods We searched PubMed, Embase, Cochrane Library, Web of Science, and clinical trials databases with no language restrictions from January 2010 to October 2023 using terms for ‘TB’, sputum, and diagnostic studies. We excluded studies with participants aged <15 years, that enrolled patients already providing sputum, or not adequately reporting information on sputum collection. Published summary data was extracted, and the risk of bias was assessed. Summary estimates for the proportion of sputum scarcity were calculated overall and by pre-specified sub-groups. The pooled proportion of sputum scarcity was calculated by random effects meta-analysis. The review protocol was registered on PROSPERO (CRD42023473882). Findings Our search identified 9895 records, of which 114 studies were included and 81 were rated as a low risk of bias. The median proportion of sputum scarcity across all 114 studies was 6.0% (95% CI: 2.9-9.1%, IQR: 0-19.9%). In subgroup meta-analyses limited to studies collecting one or two self-expectorated spot sputum samples, the pooled estimate of sputum scarcity was 23% (95%CI: 14-33%, n=27). Sputum scarcity was higher in PLHIV sub-groups. The pooled estimate of sputum scarcity in studies enrolling only PLHIV was 24% (95% CI: 15-33%, n=9) for collection of one or two self-expectorated spot sputum samples. Sputum scarcity was the highest in PLHIV inpatients or with advanced disease, with 32% (95% CI: 22-41%, n=5) unable to provide one or two self-expectorated samples. Patients without HIV had the lowest pooled estimate of scarcity, with 12% (95% CI: 3-21%, n=5) unable to provide a self-expectorated sample of any number or collection time. And studies using sputum induction to collect one or two spot samples had a pooled scarcity of 10% (95% CI: 0-21%, n=12). Interpretation Sputum scarcity is seen in nearly a quarter of patients being evaluated for TB and this compromises TB detection. These findings support the ongoing work to develop non-sputum TB tests. Funding Gates Foundation (INV-069540) Research in Context Evidence before this study Current diagnostics for tuberculosis (TB) rely on testing sputum samples, and patients unable to produce sputum at the time of evaluation may have a delayed or missed diagnosis. However, there are no reliable estimates about how many patients being evaluted for presumptive TB are unable to produce a sputum sample (sputum scarce) and how this varies in different settings and populations. Added value of this study This systematic review included data from 114 studies, and found approximately 24% of patients with presumed TB could not produce one or two sputum samples at the time of evaluation. We found higher proportions of sputum scarcity in people living with HIV, and in people living with HIV who were hospital inpatients. We found sputum scarcity was lowest in people without HIV. Implications of all the available evidence Sputum scarcity can impact nearly a quarter of patients being evaluated for TB and is more common in people living with HIV. These data support the need for non-sputum diagnostics.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,019 | 0,045 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,002 |
| Méta-épidémiologie (sens large) | 0,022 | 0,042 |
| Bibliométrie | 0,008 | 0,007 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,004 | 0,003 |
| Science ouverte | 0,003 | 0,002 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».