Critérios de Pontuação para Diagnóstico de Tuberculose em Crianças Diagnostic Scoring System for Tuberculosis in Children

Childhood tuberculosis is underreported, because of the difficulty in diagnosing tuberculosis in children, in whom the diagnosis is based on a history of contact with active tuberculosis in an adult, positive tuberculin skin test results, symptoms suggestive of tuberculosis, and radiological alterations. Diagnostic scores are established by evaluating those findings in conjunction. In this review, we discuss a number of such scores that have been proposed. Various scores for the diagnosis of pulmonary tuberculosis in children have been proposed, with only moderate to weak concordance among them. The most recent systematic review of the scores available worldwide showed that the Brazilian National Ministry of Health has sponsored more validation studies, with consistent sensitivity and specificity, than has any other such system. Techniques or diagnostic systems for childhood tuberculosis that are more efficient, rapid and affordable should be developed and validated for use at the target locale. In the interim, we suggest that diagnostic scores be employed in accordance with local regulations, such as screening through careful evaluation by a specialist, avoiding delayed or inconclusive diagnoses. Where there is a shortage of such specialists, well-trained professionals, using the available scores, will be able to diagnose tuberculosis adequately in the majority of patients.