TUBERCULOSIS: ‘Common Sense’ Eliminates Unneeded, Costly Test
Researchers at the University of California-San Diego and the San Diego County Health Department have discovered a "common clinical sense" guide to assist physicians in determining which patients should undergo testing for tuberculosis, the San Diego Union-Tribune reports. Although faster, more accurate diagnostic TB tests have been developed, physicians are reluctant to use them because they cost $150 each. According to a study published in this week's Journal of the American Medical Association, researchers have devised an effective, simple "rule-out" technique that asks physicians to use their "gut sense" in determining real TB symptoms. Researchers asked physicians at six urban medical centers and the San Diego County health clinic to rank 338 patients' risk of TB as "low," "intermediate" or "high" based on a 0-to-100 scale. Principal Investigator Dr. Antonino Catanzaro said, "We said, 'Tell us honestly. Give us a gut kind of answer. What do you think the chances are that this patient will eventually be confirmed to have TB?'"
Gut Reaction Usually Right
Researchers found that physicians gave the low ranking -- a score of 25 or lower -- to more than half of patients, none of who actually had the disease. Using the scale enables physicians to administer the expensive test to the "most highly suggestive cases." Catanzaro said, "What we found is that the computer in the doctor's brain worked better than the test to exclude patients who in all likelihood didn't have TB." Officials at the CDC hailed the report. Dr. Ken Castro, director of the CDC's Division of TB Elimination, said, "The good news is that we now have a new FDA test to help facilitate the rapid diagnosis of TB," adding that the scale enables physicians to apply the test in the most informative, cost-saving manner. However, some cautioned that the scale may be harder to use for physicians less familiar with TB. Dr. Lee Reichman, executive director of the New Jersey Medical School National Tuberculosis Center, said, "This study was done in areas with high rates of tuberculosis, at centers where physicians have a lot of experience." But, he added, "We spend $1 billion a year taking care of patients, and half of that is spent on patients who wind up not having TB" (Clark, 2/2).