Clinical Medicine and Diagnostics 2015, 5(3): 39-44 DOI: 10.5923/j.cmd.20150503.02 Value of New Modification of Tuberculosis Score in Diagnosis of Childhood Pulmonary Tuberculosis Hussein Koura 1 , Abdel-Hamead A. F. Mohammed 2,* 1 Pediatric department, Faculty of Medicine-Diametta Al-Azhar University 2 Clinical pathology department, Faculty of Medicine- Assiut, Al-Azhar University Abstract The difficulties in making an exact diagnosis of pulmonary tuberculosis in children have led to the development of different approaches for diagnosis. The aim of this study was to compare the validity of Edwards' score and a new modified Edwards' score in the diagnosis of childhood pulmonary tuberculosis. A cross sectional study was carried out at Al Azher University hospitals. One hundred twenty children were enrolled in the study and were divided to two groups. Tuberculosis group included 60 children with positive pathozyme TB complex test and respiratory symptoms and/or chest-X-ray (CXR) findings that improved using exclusively anti-tuberculosis drugs. Control group included 60 children with significant respiratory symptoms in the form of cough and or difficult breathing or tachypnea of duration not less than 7 days with or without CXR findings and who recovered from their symptoms and/or CXR findings using treatment other than anti-tuberculosis drugs and demonstrated negative pathozyme TB complex test. At enrolment the following investigations were performed: tuberculin skin test (TST), CXR postro-anterior view, complete blood count, ESR and pathozyme TB comp1ex plus test. Edwards' score and a new modified score were applied separately to all enrolled children. Sensitivity and specificity for diagnosis of pulmonary tuberculosis were higher for new modified Edwards' score than Edwards' score (93.3%, 95% versus 86.7%, 88.30% respectively). Also, positive and negative predictive values were higher for new modified Edwards' score compared with Edwards' score (95.9%, 93.4% versus 88.1%, 86.9% respectively). The mean score for diagnosis of pulmonary tuberculosis was higher in new modified Edwards' score than Edwards' score (11.4 ± 0.5 versus 10.3 ± 0.4 respectively). There was agreement between Edward score and new modified Edwards' score in diagnosis of 52 cases as pulmonary tuberculosis. It was concluded that new modified Edwards' score is better than Edwards' score in the diagnosis of childhood pulmonary tuberculosis. It was recommended to conduct a community based study with large sample size to evaluate the validity of new modified score when used on the large scale. Keywords Edwards' Score, Childhood Tuberculosis, Pathozyme TB Complex, Tuberculin Skin Test 1. Introduction The diagnosis of childhood pulmonary tuberculosis presents a major challenge, as it is complicated by the absence of a practical "gold standard" [1, 2, 26]. Sputum smear microscopy, often the only diagnostic test available in endemic areas, is positive in less than 10 to 15% of children with probable tuberculosis and culture yields are also low (30% to 40%) [3, 4, 24]. On the other hand serologic tests alone are currently unable to diagnose childhood pulmonary tuberculosis with accuracy [5], sputum-based polymerase chain reaction (PCR) tests have shown variable results and limited utility [6-9] and radiological signs are often difficult to interpret. Owing to the diagnostic limitations discussed above, a variety of clinical scoring systems have been developed to diagnose active tuberculosis in children. A * Corresponding author: abdelhamidmusa@yahoo.com (Abdel-Hamead A. F. Mohammed) Published online at http://journal.sapub.org/cmd Copyright © 2015 Scientific & Academic Publishing. All Rights Reserved critical review of these clinical scoring systems concluded that they are limited by a lack of standard symptom definitions and adequate validation [1]. Since 1996, WHO has recommended Edwards' score to use in diagnosis of childhood tuberculosis [11, 12]. Many studies were conducted to test the validity of the score in diagnosis of childhood tuberculosis but the results were different [13, 14]. After a long clinical experience in using this score for diagnosis of childhood tuberculosis, we did a modification for two items of the generic score to increase the validity of the score. Weight for length or height (W/L) was used instead of weight for age (W/A) because W/L represents wasting while W/A represents wasting and or shortness. Unexplained fever was determined by duration of more than two weeks to be more accurate. Pathozyme TB complex as "gold standard" test was added to define positive TB and control negative TB groups. This study aimed to compare the validity of Edwards' score and a new modified Edwards' score in the diagnosis of childhood pulmonary tuberculosis.