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.

INTRODUCTION

Pleural effusion classification guides management, but Light's criteria require invasive sampling and laboratory infrastructure and may be prone to misclassifications. A rapid, bedside alternative is needed, particularly in resource-limited settings.  Aim: This study aimed to develop and validate a novel, four-point sonographic scoring system, the TELL (pleural thickening (T), fluid echogenicity (E), loculations (L), and laterality (L)) score, for differentiating pleural effusions at the bedside.

MATERIALS AND

METHODS

This is a prospective observational study conducted at Saveetha Medical College Hospital, a tertiary care centre in South India from March 2021 to February 2022. Seventy-four adult patients with pleural effusions underwent thoracic ultrasonography, assessing four "TELL" parameters: pleural thickening (≥3 mm), fluid echogenicity, laterality (unilateral effusions), and presence of loculations. Each positive finding scored one point (range 0-4). Diagnostic performance was compared against Light's criteria using diagnostic indices and receiver operator characteristic (ROC) curve analysis.

RESULTS

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.