Tayo Score Blue

8/6/2019 Tayo Score Blue

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Seamen s Hospital


2/15

The Validity of a Clinical Scoring

System (Tayo Score) in the Presumptive

diagnosis of Pulmonary Tuberculosis


3/15

` Was there a comparison with a reference

standard? Yes. The Tayo scoring system was

compared to sputum AFB

` Did the patient sample include an appropriatespectrum of patients to whom the test will be

used? Yes. The patients included all had cough >

2 weeks, were suspected of having pulmonary TB,

>18yrs old, and no previous history of PTB norcurrently taking anti-TB medications


4/15

` Was the reference standard done regardless of

the result of the diagnostic test being evaluated?

Yes. All patients in the study underwent sputum

AFB.


5/15

` Were the methods for performing the test

described in sufficient detail to permit

replication? Yes. The method for performing the

test is very simple, consisting of face to faceinterviews, assigning score values to the clinical

parameters present in the patient, and getting

the total score.


6/15

` WHAT ARE THE RESULTS?

` What were the likelihood ratios for the different

possible test results?

` Likelihood ratio of a positive testLR(+) = Sn/(1-Sp)

` Likelihood ratio of a negative test

LR(-) = (1-Sn)/Sp


7/15

AFB Smear+ AFB Smear- Total

Tayo Score + 7 9 16

Tayo Score - 0 24 24

Total 7 33 40

Sn =7/7= 1 Sp = 24/33= 0.727

LR(+) = 1/(1 - 0.727) = 1/0.273=3.66

LR(-) = 1-1/0.727= 0 (the study used 0.1 instead of 0)


8/15


9/15

` Are the results applicable to my patient?

` We had no actual patient that started this

appraisal. However, the results of this study are

applicable to our patients at the OPD, and we canuse the Tayo scoring system to make a quick

assessment of the likelihood or not of the patient

with > 2weeks cough to have TB as the primary

differential diagnosis.


10/15

` Will the results change my management? No.

since AFB smear positive patients are 20x more

likely to be contagious than smear negative thenthe reverse is true: that smear negative are 20x

less likely to be contagious.` Hence, for a patient with cough of more than 2 wks duration with Tayo score

of < 16, TB is not the primary consideration and he can be worked up

sooner for other conditions and given appropriate treatment.


11/15

` If his cough persists or he does not respond to

medication or management given, then TB rises to

the forefront as a likely diagnosis and sputum AFB

becomes necessary for quick confirmation

` Recall that culture remains the gold standard for diagnosis of TB, but this is

time consuming, very costly, at not readily available in our setting. Hence

we use AFB, with its specificity of97.5-99.8%, as the confirmatory test for

TB suspects.


12/15

` The Tayo scoring system is an alternative tool to

the use of sputum AFB in all patients with cough of

>2weeks duration. Based on the study conducted

on 40 patients with >2weeks cough, only7

ofthem were detected to be AFB positive, while 16

(including the 7 mentioned) were positive for the

Tayo score.


13/15

` Using a simple interview tool with a 100%

sensitivity and specificity of72.7%, the Tayo

scoring system is excellent in detecting TB in

patients who have it, but has moderate ability toweed out persons without TB.


14/15

` However, since the purpose of the Tayo score is

to detect the people who have TB, then it is an

extremely useful diagnostic tool that can enable us

to identify TB patients rapidly when we have noaccess to microscopy, as well as save time and

energy for those who perform the AFB test and

allow them to dedicate more time to other tasks.


15/15

` Ana

` Chinit

` Joan

` Ian` Ning

` Nol

` Rommel

` Presented (to be) at St Jude, June 25, 2011

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