Cheng T L, Miller E B, Ottolini M, Brasseux C, Rosenquist G
Department of General Pediatrics, Children's National Medical Center, George Washington University, Washington, DC, USA.
Arch Pediatr Adolesc Med. 1996 Jul;150(7):682-5. doi: 10.1001/archpedi.1996.02170320028004.
To assess physician agreement with and adoption of American Academy of Pediatrics' (AAP) recommendations on tuberculosis screening in children.
Survey of a random sample of 1272 community pediatricians and family physicians (excluding academic institutions) in 4 mid-Atlantic states and the District of Columbia.
The response rate was 66%. Seventy-five percent of the respondents were aware of the 1994 AAP screening recommendations. Most (64%) test children at low risk periodically (at age 1 year, preschool age, and adolescent age), and 81% test children at high risk annually. Eighty-one percent of the respondents estimated that 10% or less of their patients were at high risk for tuberculosis. Most use patient-specific factors, geographic or community prevalence, or both as principal criteria to determine risk. Eighty-seven percent used multiple-puncture tests in 1993; this declined to 55% in 1994. Multiple-puncture tests are still used exclusively by 29% of the respondents. Ninety-one percent of those using multiple-puncture tests and 19% of those using the Mantoux test allow parents to read the test reaction. Forty-six percent of the respondents believed that if a return visit was required for reading the test reaction, 50% or less of their patients would return. Only 22% of the respondents adhere to the 1994 AAP recommendations regarding frequency, testing method, and reading the test reaction. Factors associated with adherence to AAP recommendations included physician and practice characteristics and knowledge of AAP recommendations.
Physician practice of tuberculosis testing varies widely; most do not adhere to the 1994 AAP recommendations. Most physicians vary the frequency and testing method based on a patient's risk status. The use of multiple-puncture tests has declined, although they are still widely used. Accurate reading of screening tests remains a major concern.
评估医生对美国儿科学会（AAP）关于儿童结核病筛查建议的认同度及采纳情况。
对大西洋中部4个州和哥伦比亚特区的1272名社区儿科医生和家庭医生（不包括学术机构）进行随机抽样调查。
回复率为66%。75%的受访者知晓1994年AAP的筛查建议。大多数（64%）对低风险儿童进行定期检测（1岁、学龄前和青少年时期），81%对高风险儿童进行年度检测。81%的受访者估计其患者中10%或更少为结核病高风险人群。大多数人将患者的具体因素、地理或社区患病率或两者作为确定风险的主要标准。1993年87%的人使用多针试验；1994年这一比例降至55%。29%的受访者仍仅使用多针试验。使用多针试验的人中有91%以及使用结核菌素试验的人中有19%让家长自行读取试验结果。46%的受访者认为，如果读取试验结果需要患者复诊，那么50%或更少的患者会回来复诊。只有22%的受访者遵守1994年AAP关于检测频率、检测方法和读取试验结果的建议。与遵守AAP建议相关的因素包括医生和诊所特征以及对AAP建议的了解程度。
医生的结核病检测做法差异很大；大多数人不遵守1994年AAP的建议。大多数医生根据患者的风险状况改变检测频率和检测方法。多针试验的使用有所减少，尽管仍被广泛使用。筛查试验结果的准确读取仍是一个主要问题。
