JMIR Publications

ABSTRACT

Background:

Tuberculosis (TB) remains a major cause of morbidity and death worldwide, with a significant impact on children, especially those under 5 years old. The complex diagnosis of pediatric TB, compounded by limited access to sensitive diagnostic tests, underscores the need for improved tools to enhance diagnosis and care in resource-limited settings.

Objective:

The objective of this paper is to present a telemedicine web platform, BITScreen PTB, aimed at improving the evaluation of pulmonary tuberculosis (TB) in children based on digital chest X-ray (CXR) imaging and clinical information in resource-limited settings.

Methods:

The platform was evaluated by three independent expert readers through a retrospective assessment of a dataset with 218 imaging exams of children under 3 years of age, selected from a previous study performed in Mozambique. Key aspects assessed include the usability through a standardized questionnaire, the time needed to complete the assessment through the platform, the performance of the readers to identify TB cases based on the CXR, the association between the TB features identified in the CXRs and the initial diagnostic classification and the inter-reader agreement of the global assessment and the radiological findings.

Results:

The platform usability and user satisfaction questionnaire evaluation received an average rating of 4.4 ± 0.59 out of 5. The average exam completion time ranged from 35 to 110 seconds. In addition, the study on CXR showed low sensitivity (16.3% to 28.2%) but high specificity (91.1% to 98.2%) in the assessment of the consensus case definition of pediatric TB using the platform. The CXR finding with a stronger association with the initial diagnostic classification was air space opacification (Χ21 >20.38, P<.001). The study found varying levels of inter-reader agreement, with moderate/substantial agreement for air space opacification (kappa from 0.54 to 0.67) and pleural effusion (kappa from 0.43 to 0.72).

Conclusions:

Our findings support the promising role of telemedicine platforms like BITScreen PTB in enhancing pediatric TB diagnosis access, particularly in resource-limited settings. Additionally, these platforms could facilitate the multireader and systematic assessment of CXR in pediatric TB clinical studies.