Assessment of tuberculin screening in an urban pediatric clinic
Kraut, J.R.; Christoffel, K.K.; Berkelhamer, J.E.; Boddie-Willis, C.
Pediatrics 64(6): 856-859
1979
ISSN/ISBN: 0031-4005 PMID: 514714 Document Number: 150109
The American Lung Association (ALA) and Center for Disease Control (CDC) stated that routine screening of children was an inefficient and ineffective method for detection of tuberculosis [TB] in the USA. This varied with prior recommendations. The objective was to assess prospectively tuberculin screening for an urban, primarily low socioeconomic, clinic population. A prior chart review revealed that only 36% of tuberculin tests had written documentation of results. The following improvements were made. One trained technician administered all tests and recorded data. One hospital mail box was used for receiving tuberculin test postcard results. Telephone follow-up was begun. This resulted in an increase of results documented to 84% (P < 0.001). After these improvements, the next 1233 routine screening tests over 8 mo. were prospectively studied. The written documentation rate during the study was 90%. Positive tuberculin tests [13] were found. Three patients had subsequent negative tuberculin tests. One patient received BCG as an infant and had multiple positive tuberculin tests in the past. One patient was lost to follow-up. Eight positive patients were confirmed as new converters. Of these 8 patients, six had histories of prior positive tuberculin tests, recent TB exposure, foreign travel or symptoms. Prior to the study, recording of tuberculin tests was severely deficient. Reorganization significantly increased the documentation rate. Of 1233 consecutive tests, 8 unsuspected cases were found. This is below the 1% conversion rate recommended by the CDC for routine TB screening in children. The data support the ALA-CDC statement regarding the low yield of routine tuberculin testing of healthy children. Abandoning tuberculin screening of healthy children would leave undetected a few children with unsuspected TB infection, who would be endangered.