van der Heijden Yuri F, Heerman William J, McFadden Sara, Zhu Yuwei, Patterson Barron L
Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN.
Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN.
J Pediatr. 2015 May;166(5):1240-1245.e1. doi: 10.1016/j.jpeds.2015.01.037. Epub 2015 Feb 24.
To assess how frequently pediatric practitioners perform latent tuberculosis infection (LTBI) screening according to guidelines. We hypothesized that screening occurs less frequently among children whose parents do not speak English as the primary language.
We conducted a retrospective cohort study of patients attending well-child visits in an urban academic pediatric primary care clinic between April 1, 2012, and March 31, 2013. We assessed documentation of 3 LTBI screening components and tested the association between parent primary language and tuberculin skin test (TST) placement and documentation of results.
During the study period, 387 of 9143 children (4%) had no documentation of screening question responses. Among the other 8756 children, 831 (10%) were identified as at high risk for LTBI. Of these, 514 (62%) did not have documented TST placement in the appropriate time frame. Thirty-nine of 213 children (18%) who had a TST placed did not have documented results. Multivariable regression showed that parent language was not associated with TST placement or documentation of results, but non-Hispanic Black children were more likely to not have a documented test result (aOR, 2.12; 95% CI, 1.07-4.19; P=.03) when adjusting for age, sex, parent primary language, insurance status, day of the week, and study year of TST placement.
Parent primary language was not associated with LTBI testing. However, we found substantial gaps in TST placement and documentation of TST results among high-risk children, the latter of which was associated with race/ethnicity. Targeted quality improvement efforts should focus on developing processes to ensure complete screening in high-risk children.
评估儿科医生按照指南进行潜伏性结核感染（LTBI）筛查的频率。我们假设，在父母不以英语为主要语言的儿童中，筛查的频率较低。
我们对2012年4月1日至2013年3月31日期间在一家城市学术性儿科初级保健诊所进行健康儿童检查的患者进行了一项回顾性队列研究。我们评估了三项LTBI筛查项目的记录情况，并测试了父母的主要语言与结核菌素皮肤试验（TST）的实施及结果记录之间的关联。
在研究期间，9143名儿童中有387名（4%）没有筛查问题回答的记录。在其他8756名儿童中，831名（10%）被确定为LTBI高危人群。其中，514名（62%）在适当的时间范围内没有TST实施的记录。在213名进行了TST的儿童中，39名（18%）没有结果记录。多变量回归显示，父母的语言与TST的实施或结果记录无关，但在调整了年龄、性别、父母的主要语言、保险状况、星期几以及TST实施的研究年份后，非西班牙裔黑人儿童更有可能没有测试结果的记录（调整后的比值比，2.12；95%可信区间，1.07 - 4.19；P = 0.03）。
父母的主要语言与LTBI检测无关。然而，我们发现高危儿童在TST实施和TST结果记录方面存在很大差距，后者与种族/民族有关。有针对性的质量改进工作应侧重于制定流程，以确保对高危儿童进行全面筛查。
