Development and evaluation of a scoring system for early diagnosis of bone and joint tuberculosis in a resource-limited setting: a cross-sectional study

Bone and joint tuberculosis (BJTB) presents a significant challenge in high TB burden countries, leading to serious complications and increased mortality. Early and accurate diagnosis is critical but often difficult due to limited access to deep tissue samples and low bacterial loads in lesion sites. This study proposes and evaluates a scoring system aimed at improving early diagnosis and management of BJTB.Please confirm if the author names are presented accurately and in the correct sequencechecked A cross-sectional study was conducted in a public sector hospital in Karachi, Sindh. Patients with clinical suspicion of BJTB, excluding those with severe underlying diseases or HIV infection, were enrolled. The scoring system included major criteria (joint pain, swelling/effusion, restricted range of motion, X-ray findings) and minor criteria (fever, weight loss, joint redness, current pulmonary TB, raised ESR, history or family history of TB). Patients were categorized as highly suspicious (score > 7), suspicious (score 5–7), or less suspicious (score < 5). Treatment was initiated based on these categories, and outcomes were monitored over a 6-month follow-up period. Of the 78 patients, 37 (47.43%) were classified as highly suspicious, 26 (33.33%) as suspicious, and 15 (19.23%) as less suspicious. Initial anti-tuberculosis treatment (ATT) was effective in 94.59% of highly suspicious cases, 84.61% of suspicious cases, and 60% of less suspicious cases. The scoring system demonstrated a sensitivity of 94.6%, 84.6%, and 73.3%, specificity of 75.0%, 69.2%, and 84.6%, and positive predictive value (PPV) of 87.2%, 84.6%, and 84.6%, and negative predictive value (NPV) of 88.5%, 83.3%, and 74.7% for highly suspicious, suspicious, and less suspicious categories, respectively. The proposed scoring system is a valuable tool for diagnosing BJTB, especially in resource-limited settings. It promotes early identification and treatment, potentially improving patient outcomes. Further studies are needed to validate its widespread applicability.Affiliations: Journal instruction requires a city/country for affiliations; however, this is missing in affiliation [1, 2, 3, 4, 5, 6, 7, 8, 9, 10]. Please verify if the provided city/country is correct and amend if necessary.checked