Development and Validation of the TELL Score (Pleural Thickening (T), Fluid Echogenicity (E), Loculations (L), and Laterality (L)): A Structured Sonographic Approach to Classifying Pleural Effusions

Among 74 participants (mean age 58.7±17.2 years; 59.5% male), 64 effusions (86.5%) were exudates, mainly tuberculosis and malignancy. Sonographic features were more common in exudates: pleural thickening (95.3%), echogenicity (98.4%), loculations (29.7%), and unilateral distribution (85.9%; all p < 0.01). At cut-off ≥2, the TELL score achieved 98.4% sensitivity, 40% specificity, negative predictive value (NPV) 80%, and area under the curve (AUC) 0.79 (95% confidence interval CI: 0.64-0.94) Conclusions: The TELL score is a rapid, non-invasive screening tool with high sensitivity and NPV, particularly useful when lab confirmation is delayed or unavailable. Multicentre validation and reliability studies in larger cohorts are needed.