Assessment of Tuberculin Screening in an Urban Pediatric Clinic

The American Lung Association (ALA) and Center for Disease Control (CDC) have stated that routine screening of children is an inefficient and ineffective method for detection of tuberculosis in the United States. This is at variance with prior recommendations. Our objective, therefore, was to assess prospectively tuberculin screening for our 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: (1) One trained technician administered all tests and recorded data. (2) One hospital mail box was used for receiving tuberculin test postcard results. (3) Telephone follow-up was begun. This resulted in an increase of results documented to 84% (P .001). After these improvements, we prospectively studied the next 1,233 routine screening tests over a period of eight months. The written documentation rate during the study was 90%. Thirteen positive tuberculin tests were found. Three patients had subsequent negative tuberculin tests. One patient received Calmette-Guerin bacillus (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 eight patients, six had histories of prior positive tuberculin tests, recent TB exposure, foreign travel, or symptoms. We conclude that: (1) Prior to the study, recording of tuberculin tests was severely deficient. (2) Reorganization significantly increased the documentation rate. (3) Of 1,233 consecutive tests, eight unsuspected cases were found. This is below the 1% conversion rate recommended by the CDC for routine TB screening in children. (4) The data support the ALA-CDC statement regarding the low yield of routine tuberculin testing of healthy children. (5) However, abandoning tuberculin screening of healthy children would leave undetected a few children with unsuspected tuberculosis infection, who would then be in danger of developing serious illness.