Document Type
Article
Publication Date
2021
Keywords
CART analysis, decision trees, pediatrics, tuberculosis
Digital Object Identifier (DOI)
https://doi.org/10.1093/ofid/ofab487
Abstract
Background: There is a dearth of research to understand which children, among those who are exposed at home to tuberculosis (TB), are at the highest risk of TB disease, to tailor care. We sought to identify predictors of TB progression in children.
Methods: We conducted a prospective cohort study of children living with adults with pulmonary TB in Lima, Peru (2009–2012). We applied classification and regression tree analysis to examine potential predictors of incident TB disease during 12 months in 3 age groups (0–4, 5–9, and 10–14 years). We calculated the relative risk (RR) for top predictors in each age group.
Results: Among 4545 children 0–14 years old, 156 (3.4%) were diagnosed with TB within 1 year of household exposure to TB (3.4%, 2.3%, and 4.7% in children 0–4, 5–9, and 10–14 years old, respectively). The most important predictor of TB was having a positive tuberculin skin test (TST) result, with RRs of 6.6 (95% CI, 4.0–10.7), 6.6 (95% CI, 3.2–13.6), and 5.2 (95% CI, 3.0–9.0) in the age groups 0–4, 5–9, and 10–14 years, respectively. In young children with a positive TST, not using isoniazid preventive treatment further increased risk of disease (RR, 12.2 [95% CI, 3.8–39.2]).
Conclusions: We present a tool that identifies child household contacts at high risk of TB disease progression based on data collected during contact tracing. In addition to the use of TB preventive therapy for all children exposed at home to TB, those children at highest risk of progressing to TB disease may benefit from more frequent follow-up.
Rights Information
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Was this content written or created while at USF?
Yes
Citation / Publisher Attribution
Open Forum Infectious Diseases, v. 8, issue 11, art. ofab487
Scholar Commons Citation
Brooks, Meredith B.; Lecca, Leonid; Contreras, Carmen; Calderon, Roger; Yataco, Rosa; Galea, Jerome; Huang, Chuan-Chin; Murray, Megan B.; and Becerra, Mercedes C., "Prediction Tool to Identify Children at Highest Risk of Tuberculosis Disease Progression Among Those Exposed at Home" (2021). Social Work Faculty Publications. 167.
https://digitalcommons.usf.edu/sok_facpub/167
