A clinical algorithm for triaging patients with significant lymphadenopathy in primary health care settings in Sudan : original research

Background: Tuberculosis is a major health problem in developing countries. The distinction between tuberculous lymphadenitis, non-specific lymphadenitis and malignant lymph node enlargement has to be made at primary health care levels using easy, simple and cheap methods. Objective: To develop a reliable clinical algorithm for primary care settings to triage cases of non-specific, tuberculous and malignant lymphadenopathies. Methods: Calculation of the odd ratios (OR) of the chosen predictor variables was carried out using logistic regression. The numerical score values of the predictor variables were weighed against their respective OR. The performance of the score was evaluated by the ROC (Receiver Operator Characteristic) curve. Results: Four predictor variables; Mantoux reading, erythrocytes sedimentation rate (ESR), nocturnal fever and discharging sinuses correlated significantly with TB diagnosis and were included in the reduced model to establish score A. For score B, the reduced model included Mantoux reading, ESR, lymph-node size and lymph-node number as predictor variables for malignant lymph nodes. Score A ranged 0 to 12 and a cut-off point of 6 gave a best sensitivity and specificity of 91% and 90% respectively, whilst score B ranged -3 to 8 and a cut-off point of 3 gave a best sensitivity and specificity of 83% and 76% respectively. The calculated area under the ROC curve was 0.964 (95% CI, 0.949 - 0.980) and -0.856 (95% CI, 0.787 - 0.925) for scores A and B respectively, indicating good performance. Conclusion: The developed algorithm can efficiently triage cases with tuberculous and malignant lymphadenopathies for treatment or referral to specialised centres for further work-up. Un algorithme clinique pour le triage des patients atteints de lymphadénopathie importante dans les milieux de soins de santé primaires au Soudan Présentation: La tuberculose est un problème de santé majeur dans les pays en voie de développement. La distinction entre tuberculose ganglionnaire, lymphadénite non spécifique et l'élargissement malin des ganglions lymphatiques doit être opérée au niveau des centres de soins de santé primaires en adoptant des méthodes simples à appliquer et peu co-teuses. Objectif: Développer un algorithme clinique pour les centres de soins de santé primaires afin de trier les cas de tuberculose ganglionnaire, de lymphadénite non spécifique et des lymphadénopathies tuberculeuses et malignes. Méthodes: Le calcul des rapports de cote (RC) d