Importance This was the first study, to the authors' knowledge, to statistically evaluate the predictive accuracy of Collaborative Ocular Tuberculosis Study (COTS) calculator in guiding initiation of antitubercular therapy (ATT) in patients with clinically suspicious tubercular uveitis (TBU) in an international cohort. Objective To evaluate the accuracy of a score of 4 or greater on the online COTS calculator in recommending ATT initiation. Design, Setting, and Participants This study was an evaluation of a diagnostic test or technology. Data input required for the COTS calculator were extracted from the COTS-1 study dataset, which comprised retrospective, observational records of patients with TBU who were monitored for 12 months after treatment. Patients were recruited from international ophthalmic centers. In the absence of a traditional criterion standard, the 12-month treatment response to ATT was used to classify patients as disease positive or negative. The accuracy of clinicians at the ATT decision-making stage in the COTS-1 study was set against COTS calculator scores of 4 or greater. Diagnostic accuracy metrics, including sensitivity, specificity, positive predictive value (PPV), precision, recall, and F1 score, were computed. Data collected from January 2004 to December 2014 were analyzed. Exposures COTS calculator to guide initiation of ATT in patients with TBU. Main Outcomes and Measures Comparison of accuracy between clinician judgment and the COTS calculator, analyzed at varying scores and further stratified by tuberculosis endemicity. Results Of the 492 participants (mean [SD] age, 42.3 [19.0] years; 233 male [47.3%]), application of the COTS calculator identified 225 (45.7%) with high or very high probability to start ATT (score = 4 or 5) and 111 (22.5%) with very high probability alone (score = 5). COTS-5 exhibited the highest specificity (88.7%; 95% CI, 81.4%-93.8%) compared with clinician judgment (29.6%; 95% CI, 21.4%-38.8%), and clinician judgment led in sensitivity (95.5%; 95% CI, 92.9%-97.4%) compared with COTS-5 (26%; 95% CI, 21.6%-30.7%). COTS-4 and COTS-5 balanced specificity (64.3%; 95% CI, 54.9%-73.1%) and sensitivity (48.8%; 95% CI, 43.7%-54%). PPV and sensitivity were consistently higher in the endemic group for all 3 tests. Conclusions and Relevance Results of this diagnostic study suggest that the COTS calculator (score ≥4) was more specific than clinician judgment for ATT initiation. Although clinician judgment is a good first step to identify all potential true positives (with high sensitivity), a second consultation with COTS-5 (with high PPV) may lead to less false positives. This tool, apt for high-prevalence, low-resource settings, recommends ATT more selectively for genuine TBU cases. Large prospective studies are essential to explore potential improvements in the calculator's sensitivity.

中文翻译：

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结核性葡萄膜炎在线协作眼结核研究计算器的验证。


重要性 据作者所知，这是第一项统计评估协作眼结核病研究 （COTS） 计算器在指导国际队列中临床可疑结核葡萄膜炎 （TBU） 患者开始抗结核治疗 （ATT） 的预测准确性的研究。目的 评估在线 COTS 计算器上 4 分或更高分数在推荐 ATT 启动方面的准确性。设计、设置和参与者 本研究是对诊断测试或技术的评估。COTS 计算器所需的数据输入是从 COTS-1 研究数据集中提取的，该数据集包括治疗后监测 12 个月的 TBU 患者的回顾性观察记录。患者是从国际眼科中心招募的。在没有传统标准标准的情况下，对 ATT 的 12 个月治疗反应用于将患者分类为疾病阳性或阴性。在 COTS-1 研究中，临床医生在 ATT 决策阶段的准确性与 4 分或更高的 COTS 计算器分数进行了对比。计算诊断准确性指标，包括敏感性、特异性、阳性预测值 （PPV） 、精度、召回率和 F1 评分。分析了 2004 年 1 月至 2014 年 12 月收集的数据。暴露 COTS 计算器指导 TBU 患者开始 ATT。主要结果和措施 临床医生判断与 COTS 计算器之间准确性的比较，以不同的分数进行分析，并按结核病流行进一步分层。结果 在 492 名参与者 （平均 [SD] 年龄，42.3 [19.0] 岁;233 名男性 [47.3%]）中，COTS 计算器的应用确定了 225 名 （45.7%） 开始 ATT 的可能性很高或非常高 （分数 = 4 或 5） 和 111 名 （22.5%），仅具有非常高的概率 （分数 = 5）。与临床医生判断 （29.6%;95% CI， 21.4%-38.8%） 相比，COTS-5 表现出最高的特异性 （88.7%;95% CI， 81.4%-93.8%），与 COTS-5 （26%;95% CI， 21.6%-30.7%） 相比，临床医生判断在敏感性 （95.5%;95% CI， 92.9%-97.4%） 方面领先。COTS-4 和 COTS-5 平衡了特异性 （64.3%;95% CI，54.9%-73.1%） 和敏感性 （48.8%;95% CI，43.7%-54%）。在所有 3 项测试中，流行组的 PPV 和敏感性始终较高。结论和相关性 这项诊断研究的结果表明，COTS 计算器 （评分 ≥4） 比临床医生对 ATT 启动的判断更具体。尽管临床医生的判断是识别所有潜在真阳性（具有高敏感性）的良好第一步，但第二次咨询 COTS-5（具有高 PPV）可能会减少假阳性。该工具适用于高患病率、低资源环境，对于真正的 TBU 病例，更有选择性地推荐 ATT。大型前瞻性研究对于探索计算器灵敏度的潜在改进至关重要。