Importance: This was the first study, to the authors' knowledge, to statistically evaluate the predictive accuracy of Collaborative Ocular Tuberculosis Study (COTS) calculator in guiding initiation of antitubercular therapy (ATT) in patients with clinically suspicious tubercular uveitis (TBU) in an international cohort.
Objective: To evaluate the accuracy of a score of 4 or greater on the online COTS calculator in recommending ATT initiation.
Design, Setting, And Participants: This study was an evaluation of a diagnostic test or technology. Data input required for the COTS calculator were extracted from the COTS-1 study dataset, which comprised retrospective, observational records of patients with TBU who were monitored for 12 months after treatment. Patients were recruited from international ophthalmic centers. In the absence of a traditional criterion standard, the 12-month treatment response to ATT was used to classify patients as disease positive or negative. The accuracy of clinicians at the ATT decision-making stage in the COTS-1 study was set against COTS calculator scores of 4 or greater. Diagnostic accuracy metrics, including sensitivity, specificity, positive predictive value (PPV), precision, recall, and F1 score, were computed. Data collected from January 2004 to December 2014 were analyzed.
Exposures: COTS calculator to guide initiation of ATT in patients with TBU.
Main Outcomes And Measures: Comparison of accuracy between clinician judgment and the COTS calculator, analyzed at varying scores and further stratified by tuberculosis endemicity.
Results: Of the 492 participants (mean [SD] age, 42.3 [19.0] years; 233 male [47.3%]), application of the COTS calculator identified 225 (45.7%) with high or very high probability to start ATT (score = 4 or 5) and 111 (22.5%) with very high probability alone (score = 5). COTS-5 exhibited the highest specificity (88.7%; 95% CI, 81.4%-93.8%) compared with clinician judgment (29.6%; 95% CI, 21.4%-38.8%), and clinician judgment led in sensitivity (95.5%; 95% CI, 92.9%-97.4%) compared with COTS-5 (26%; 95% CI, 21.6%-30.7%). COTS-4 and COTS-5 balanced specificity (64.3%; 95% CI, 54.9%-73.1%) and sensitivity (48.8%; 95% CI, 43.7%-54%). PPV and sensitivity were consistently higher in the endemic group for all 3 tests.
Conclusions And Relevance: Results of this diagnostic study suggest that the COTS calculator (score ≥4) was more specific than clinician judgment for ATT initiation. Although clinician judgment is a good first step to identify all potential true positives (with high sensitivity), a second consultation with COTS-5 (with high PPV) may lead to less false positives. This tool, apt for high-prevalence, low-resource settings, recommends ATT more selectively for genuine TBU cases. Large prospective studies are essential to explore potential improvements in the calculator's sensitivity.
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http://dx.doi.org/10.1001/jamaophthalmol.2024.4567 | DOI Listing |
JAMA Ophthalmol
December 2024
Lee Kong Chian School of Medicine, Nanyang Technological University of Singapore.
Data Brief
February 2024
Internet of Things (IoT) Lab, Department of Engineering and Architecture, University of Parma, Parma 43124, Italy.
The experimental dataset (organized in a semicolon-separated text format) is composed by air quality records collected over a 1-year period (October 2022-October 2023) in an indoor travelers' transit area in the Brindisi airport, Italy. In detail, the dataset consists of three CSV files (ranging from 7M records to 11M records) resulting from the on-field data collection performed by three prototypical (IoT) sensing nodes, designed and implemented at the IoTLab of the University of Parma, Italy, featuring a Raspberry Pi 4 (as processing unit) which three low-cost commercial sensors (namely: Adafruit MiCS5524, Sensirion SCD30, Sensirion SPS30) are connected to. The sensors sample the air in the monitored static indoor environment every 2 s.
View Article and Find Full Text PDFSensors (Basel)
December 2022
Fraunhofer IOSB, Gutleuthausstr. 1, 76275 Ettlingen, Germany.
Eye (Lond)
May 2023
Advanced Eye Centre, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Objective: To introduce the Collaborative Ocular Tuberculosis Study (COTS) Calculator, an online clinical scoring system for initiating antitubercular therapy (ATT) in patients with ocular tuberculosis (TB).
Method: The COTS Calculator was derived from COTS Consensus (COTS CON) data, which has previously published consensus guidelines. Using a two-step Delphi method, 81 experts evaluated 486 clinical scenario-based questions, ranking their likelihood of initiating ATT in each specific scenario.
J Patient Saf
October 2022
Infusion and Vascular Access Nurse, Nursing Care Research, Hospital del Mar Research Institute (IMIM), Barcelona.
Objective: Our objective was to evaluate the cost-effectiveness of the use of peripherally inserted central venous catheters (PICCs) by a vascular access team (VAT) versus central venous catheters (CVCs) for in-hospital total parenteral nutrition (TPN).
Methods: The study used a cost-effectiveness analysis based on observational data retrospectively obtained from electronic medical records from 2018 to 2019 in a teaching hospital. We included all interventional procedures requiring PICCs or CVCs with the indication of TPN.
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