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Yield of chest X-ray tuberculosis screening of immigrants during the European refugee crisis of 2015: a single-centre experience

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Abstract

Objective

Our aim was to determine the prevalence of tuberculosis (TB), the number needed to screen (NNS), and the diagnostic accuracy of chest X-ray (CXR) screening to detect active pulmonary TB during the 2015 European refugee crisis.

Materials and methods

We evaluated data of all refugees who underwent CXR screening in a single-centre of one German metropolitan area in 2015. We determined the prevalence of TB, NNS, and accuracy of CXR to detect active pulmonary TB. Reference method for active TB was the database of all definite TB cases registered at the Department of Public Health.

Results

A total of 17,487 immigrants underwent single-centre CXR screening in 2015; prevalence of definite pulmonary TB was 0.103%. The NNS for detecting one case of active pulmonary TB was 1749. CXR had a sensitivity of 55.6% [95% confidence interval (CI) 30.8–78.5%) and a specificity 98.3% (CI 98.1–98.5%) to reveal one case of active TB.

Conclusion

Our single-centre study indicates that chest X-ray screening for TB during the 2015 European refugee crisis was of low yield due the low prevalence of TB and high number needed to screen, thus implicating the need for improved screening algorithms adapted to the overwhelming number of refugees.

Key Points

Prevalence of pulmonary tuberculosis (TB) among refugees in 2015 was low (0.103%).

The number needed to screen to detect one case of active pulmonary TB was 1749.

Tuberculosis X-ray screening resulted in a low sensitivity and high specificity.

Tuberculosis X-ray screening during the European refugee crisis is of low yield.

Improved screening algorithms are needed due to the overwhelming the number of refugees.

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Acknowledgements

The scientific guarantor of this publication is Dr. Julius Matthias Weinrich. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Mr. Gerhard Schön kindly provided statistical advice for this manuscript. One of the authors has significant statistical expertise. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Weinrich, J.M., Diel, R., Sauer, M. et al. Yield of chest X-ray tuberculosis screening of immigrants during the European refugee crisis of 2015: a single-centre experience. Eur Radiol 27, 3244–3248 (2017). https://doi.org/10.1007/s00330-016-4684-9

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  • DOI: https://doi.org/10.1007/s00330-016-4684-9

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