We recently read with interest the article written by Wisnivesky et al1 about the prospective validation of a prediction model for isolating inpatients with suspected pulmonary TB. As expected, their prediction rule did not perform as accurately in the validation cohort as in the population in which it was established,2 but its sensitivity was similar (95% vs 98%) and its specificity was only moderately lower (35% vs 46%), still reducing the number of unnecessary episodes of respiratory isolation by 35% compared with current practices in their institutions. However, it must be stressed that these results were obtained in a population with a very high prevalence of human immunodeficiency virus (HIV) infection. Indeed, 362 patients (70%) of the 516 enrolled in the study were infected with HIV, whereas only 9% of the patients diagnosed with TB in United States in 2003 tested positive for HIV.3
Tattevin P, Bouvet E. A Prediction Model for Isolating Inpatients With Suspected Pulmonary Tuberculosis. Arch Intern Med. 2005;165(15):1794–1795. doi:10.1001/archinte.165.15.1794-b
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