{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T20:09:35Z","timestamp":1778011775274,"version":"3.51.4"},"reference-count":24,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Active pulmonary tuberculosis (aPTB) in the Older Adults (\u226575 years) is frequently under-recognized in non-pulmonology settings due to atypical symptoms and multiple comorbidities. This study aimed to develop and validate a TRIPOD-compliant clinical prediction model for early identification of atypical aPTB in this vulnerable population. Materials and Methods: We retrospectively analyzed 5651 patients aged \u226575 years with culture-confirmed aPTB and World Health Organization (WHO) symptom scores &lt; 5. Patients were stratified into Group a (Ga, Patients with aPTB not initially suspected by non-pulmonologists (atypical presentation, WHO\/CDC 7-point score &lt; 5, n = 1155) and Group b (Gb, Patients without aPTB within the first 24 h (non-TB comparators), n = 4496). Multivariate logistic regression identified independent predictors of delayed diagnosis. A weighted scoring system was derived from \u03b2-coefficients and validated in independent derivation (2000\u20132020) and temporal validation (2021\u20132023) cohorts. Model discrimination, calibration, and decision curve analysis (DCA) were assessed following TRIPOD standards. Results: Five independent predictors\u2014age &gt; 85 years (OR = 6.31, 95% CI = 5.31\u20138.72), hypoalbuminemia (OR = 4.10, 95% CI = 3.92\u20137.26), cardiovascular disease (OR = 3.32, 95% CI = 1.23\u20135.27), diabetes mellitus (OR = 2.03, 95% CI = 1.32\u20134.07), and predominant lower-lung field involvement (OR = 1.25,95% CI = 1.03\u20132.44)\u2014were incorporated into the scoring model. Using a cutoff \u2265 7, the model achieved excellent performance across all cohorts (AUC 0.95\u20130.96; sensitivity 91\u201394%; specificity 97\u201399%). Calibration plots and DCA confirmed strong agreement and high net clinical benefit. Nearly 70% of atypical cases had symptom scores \u2264 1, lacking typical signs such as fever or cough. Conclusions: Oldest-old (&gt;85 years) emerged as the strongest independent predictor of atypical TB, surpassing conventional frailty indicators such as sarcopenia or osteoporosis. The proposed score provides a simple, accurate, and validated tool for early detection of aPTB in non-pulmonology settings. Its integration into electronic medical records may reduce diagnostic delays and improve outcomes in this high-risk, late-elderly population.<\/jats:p>","DOI":"10.3390\/medicina61101888","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T15:36:31Z","timestamp":1761060991000},"page":"1888","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Clinical Prediction Model for Atypical Tuberculosis Manifestations Among Older Adults"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4368-7880","authenticated-orcid":false,"given":"Jun-Jun","family":"Yeh","sequence":"first","affiliation":[{"name":"Department of Thoracic Medicine, Family Medicine, Geriatric Medicine, Medical Research, and Medical Education, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600566, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jia-Hong","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiologic Medicine, Chest Medicine, and Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600566, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi-Ling","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of Nutrition Medicine, Chest Medicine, and Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600566, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9526-1825","authenticated-orcid":false,"given":"Chieh-Hsuan","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Chest Medicine, and Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600566, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yung-En","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Thoracic Medicine, Family Medicine, Geriatric Medicine, Medical Research, and Medical Education, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600566, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Goletti, D., Meintjes, G., Andrade, B.B., Zumla, A., and Shan Lee, S. 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