Identification of children at risk of developing tuberculosis

According to a study published in the January issue of JAMA, using a questionnaire as a screening method to assess the risk of developing tuberculosis, skin tests with tuberculin can be avoided in 86% of children.

A survey was conducted of 2,920 children aged 1 to 18 years old, and all of them underwent tuberculin skin tests. The questionnaire included questions about the child's contact with a TB patient, visits to areas where TB is endemic, and contacts with adults at high risk for TB and HIV infection. Similar questions were previously recommended by the American Pediatric Academy in order to select the category of children who need staging of tuberculin skin samples.

The survey found that 14% of children had one or more risk factors for tuberculosis. Of these, 5.6% of skin test results were positive and only 0.16% of children with positive sensitivity to tuberculin were not detected during the survey.

The prognostic value of a positive survey result was low (5.4%), but the sensitivity, specificity and prognostic value of a negative questionnaire were high (85.2%, 86.0%, 99, 8%, respectively). Four children who were not identified during screening and who subsequently had a positive tuberculin skin test were over 11 years of age. According to the researchers, this group could be ignored during a screening survey because older children have an increased risk of contact with tuberculosis patients outside their own home.

The proposed questionnaire is an easy way to determine if a child needs a tuberculin test. If at least one risk factor is identified, the probability of the tuberculin test being positive increases by 35 times.

The researchers' questionnaire will help distribute the children to those who need further investigation and to those who do not. Although scientists have not specifically calculated economic efficiency, it is obvious that this approach will save significant funds.