{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:29:02Z","timestamp":1785432542798,"version":"3.56.0"},"posted":{"date-parts":[[2026,7,10]]},"group-title":"Infectious Diseases (except HIV\/AIDS)","reference-count":31,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"award":["101103283 decide-tb M-BM-^ horizon-ju-gh-edctp3-2022-01"],"award-info":[{"award-number":["101103283 decide-tb M-BM-^ horizon-ju-gh-edctp3-2022-01"]}],"id":[{"id":"https:\/\/ror.org\/00k4n6c32","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,7,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The World Health Organization (WHO) recommends 4-month treatment for children with non-severe pulmonary tuberculosis, outlining eligibility criteria for settings with and without chest X-ray (CXR). We evaluated the diagnostic accuracy of the WHO eligibility criteria in settings without CXR (WHO-criteria) and developed clinical scores to support disease classification.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Using data from an individual participant dataset (IPD; Decide TB) of children with confirmed\/unconfirmed tuberculosis from four diagnostic studies (RaPaed-TB, Umoya, TB-Speed HIV, TB-Speed Decentralisation), we assessed the diagnostic accuracy of the WHO-criteria (with\/without bacteriological testing) using expert CXR interpretation as a reference. We developed two multivariable logistic regression models with (Score 1) and without (Score 2) bacteriological testing, converted coefficients into integer scores with a threshold of &gt;10 corresponding to a sensitivity \u226570%.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 2,383 children in the Decide TB IPD, 633 (26.6%) met the eligibility criteria for a 4-month regimen, of whom 116 (18.3%) had radiologically severe disease. With and without bacteriological testing, the WHO-criteria had sensitivities of 30.1% (95%CI: 20.3%-40.2%) and 21.7% (95%CI: 10.4%-34.5%), and specificities of 83.4% (95%CI: 80.2%-86.4%) and 81.9% (95%CI: 78.8%-84.9%), respectively. Score 1 and Score 2 had sensitivities of 41.1% (95%CI: 32.4%-49.5%) and 30.9% (95%CI: 22.6%-40.4%), and specificities of 77.3% (95%CI: 73.6%-80.8%) and 83.0% (95%CI: 79.5%-86.3%), respectively. Using WHO-criteria, 91\/116 (78.4%) and 105\/116 (90.5%) of children were at risk of undertreatment, compared to 68\/116 (58.6%) and 80\/116 (68.9%) when using developed scores.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Developed scores demonstrated better sensitivity than WHO-criteria, however, performance remained suboptimal. Implementing shorter antituberculosis regimens without CXR remains challenging in children.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.07.07.26357441","type":"posted-content","created":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T04:15:13Z","timestamp":1783743313000},"source":"Crossref","is-referenced-by-count":0,"title":["Predicting radiological severity of pulmonary tuberculosis in children: an assessment of the WHO-criteria and novel prediction scores on an individual participant dataset"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8687-7350","authenticated-orcid":false,"given":"Akshita","family":"Gupta","sequence":"first","affiliation":[{"name":"Institute of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich"},{"name":"German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marieke M.","family":"van der Zalm","sequence":"additional","affiliation":[{"name":"Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9471-4488","authenticated-orcid":false,"given":"Minh Huyen Ton Nu","family":"Nguyet","sequence":"additional","affiliation":[{"name":"University of Bordeaux, National Institute for Health and Medical Research (Inserm) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8827-019X","authenticated-orcid":false,"given":"Marc","family":"d\u2019Elb\u00e9e","sequence":"additional","affiliation":[{"name":"University of Bordeaux, National Institute for Health and Medical Research (Inserm) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5825-9347","authenticated-orcid":false,"given":"Peter J.","family":"Dodd","sequence":"additional","affiliation":[{"name":"Sheffield Centre for Health and Related Research, School of Medicine & Population Health, University of Sheffield, Sheffield, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Palmer","sequence":"additional","affiliation":[{"name":"Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leyla","family":"Larsson","sequence":"additional","affiliation":[{"name":"Institute of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich"},{"name":"Clinical Research Department, Faculty of Infectious and Tropical Diseases, London 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