EHR tool identifies 100% of TB cases
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Key takeaways:
- “TBorNotTB” is a clinical decision support system embedded in the electronic health record.
- The system demonstrated 100% sensitivity and 27% specificity for identifying patients with TB.
Researchers developed a computer-based tool to evaluate hospitalized patients for suspected tuberculosis that correctly identified 100% of cases, which could help prevent spread to other patients, they said.
“Infection prevention and control programs are tasked with implementing appropriate isolation of patients in health care facilities with suspected or confirmed communicable diseases to reduce the risk of health care-associated infections to patients and mitigate occupational risks to health care personnel,” Caitlin Dugdale, MD, MSc, an infectious disease physician at Massachusetts General Hospital, told Healio.
Dugdale noted that rates of TB have been increasing in the United States over the last several decades. According to recent data from CDC, 2023 had the highest number of TB cases in the U.S. since 2013. Specifically, 9,615 TB cases were reported in 2023 — a 16% increase from 2022 and an 8% increase from 2019.
“When patients who are displaying signs of TB come into health care settings, specific precautions must be taken to reduce the risk of exposure to other patients, visitors, and health care personnel,” Dugdale said, adding that it is important to maintain these precautions until it is determined that TB is “very unlikely,” so the patient does not pose a risk to others.
“However, it is also important to promptly remove these TB precautions when there is no longer suspicion for TB since patient isolation can negatively impact access to care, clinical workflows, and hospital bed capacity,” she said.
To help assist clinicians through diagnostic evaluation of patients hospitalized with suspected pulmonary TB in low-prevalence settings, a team of infection prevention experts, infectious disease physicians and researchers at Massachusetts General Hospital developed a risk scoring tool for electronic health records called “TBorNotTB.”
They explained that the tool assigns points based on factors, including epidemiologic risk factors, TB history, symptoms and chest imaging. If points are below a set threshold, airborne isolation precautions are discontinued; otherwise, additional evaluation is recommended, according to the study.
Dugdale and colleagues assessed the tool by retrospectively applying it to all patients hospitalized with TB in the Mass General Brigham system between July 2016 and December 2022, as well as an equal number of age- and date of testing-matched controls.
Ultimately, 104 patients with TB and 104 controls were included in the evaluation. According to the study, the tool demonstrated 100% sensitivity by identifying 100% of cases and recommending the discontinuation of TB isolation precautions. It also demonstrated 27% specificity for TB while automatically ruling out TB infection in more than a quarter of control group patients.
Additionally, the tool helped researchers identify several predictors of TB in the case-control analysis. They determined that prior residence in a highly TB endemic country was the strongest epidemiologic risk factor for TB (OR = 5.7; 95% CI, 2.6-12.8).
Although they determined that other traditional epidemiologic risk factors for TB were not “significantly predictive,” other factors including positive interferon gamma release assay (OR = 6.7; 95% CI, 3.4-13.7), weight loss (OR = 2.3; 95% CI, 1.3-4.2), and the absence of symptom resolution with treatment for alternative diagnoses (OR = 0.0; 95% CI, 0.0-0.1).
“The TBorNotTB Clinical Decision Support Tool demonstrated modest specificity and very high sensitivity to detect TB even when initial TB testing was negative,” Dugdale said. “This tool, embedded into the electronic medical record system, could help reduce risks of health care-associated TB transmission, patient time in isolation precautions, and clinician time spent reviewing individuals with suspected TB.”
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