SYSTEMATIC REVIEW article
Front. Pediatr.
Sec. Pediatric Infectious Diseases
Volume 13 - 2025 | doi: 10.3389/fped.2025.1616608
Clinical Characteristics Leading to Misdiagnosis of Abdominal Tuberculosis in Children: A Systematic Review and Meta-Analysis Manuscript type: A systematic review and meta-analysis
Provisionally accepted
- 1Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, China
- 2Karnali Academy of Health Sciences, Chandannath, Nepal
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Abstract Introduction: Abdominal tuberculosis (ATB) in children is an uncommon form of extrapulmonary tuberculosis that often presents with nonspecific symptoms. These features frequently overlap with other abdominal conditions, increasing the risk of misdiagnosis or delay in diagnosis. While individual case series have reported such diagnostic challenges, a pooled analysis of clinical characteristics associated with misdiagnosis has not been previously conducted. This study aimed to identify which clinical characteristics may contribute to the misdiagnosis of ATB in children through a systematic review and meta-analysis.Methods: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. A comprehensive literature search was carried out using PubMed, Web of Science, and Google Scholar for studies published between 1900 and 2024. Eligible studies were pediatric case series that included confirmed ATB cases and provided information on initial misdiagnosis or diagnostic delays. Patients who were misdiagnosed or delayed in diagnosis were categorized under the “misdiagnosed” group. Data were extracted on presenting clinical features, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using Review Manager (RevMan 5.4). Heterogeneity was assessed using the I² statistic, and publication bias was evaluated using funnel plots.Result: Seven studies met the inclusion criteria, comprising a total of 60 pediatric ATB cases. Among them, 24 were classified as misdiagnosed and 36 were diagnosed without delay. No clinical characteristics were statistically significantly associated with misdiagnosis. While ascites and abdominal distension were more frequently observed in misdiagnosed cases, Overall heterogeneity was low across most outcomes.Conclusions: Clinical characteristics alone are not reliable indicators for diagnosing abdominal tuberculosis (ATB). Ascites and abdominal distension may increase the risk of misdiagnosis, underscoring the importance of early suspicion and timely diagnostic evaluation in TB-endemic regions.
Keywords: Abdominal tuberculosis, Children, Misdiagnosis, diagnostic delay, clinical characteristic, Meta-analysis
Received: 23 Apr 2025; Accepted: 05 Aug 2025.
Copyright: © 2025 SIDDIQUI, Karmacharya, Wan, Zhu, Shuanghong and Wan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Chaomin Wan, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
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