Christy C, Pulcino M L, Lanphear B P, McConnochie K M
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, NY, USA.
Arch Pediatr Adolesc Med. 1996 Jul;150(7):722-6. doi: 10.1001/archpedi.1996.02170320068011.
To determine the proportion of children who are at high risk for tuberculosis (TB) as defined by the American Academy of Pediatrics (AAP) criteria, the rate of compliance with visits for tuberculin skin test (TST) interpretation, and the prevalence of TB infection.
A cross-sectional study of 401 children, 12 months to 18 years of age, who attended a hospital-based, urban pediatric clinic for well-child visits was undertaken from April 13, 1994, through August 30, 1994. Respondents completed a self-administered questionnaire, an intradermal TST was applied, and an appointment was scheduled for skin test interpretation in 48 to 72 hours.
Hospital-based, pediatric primary care center in Rochester, NY, serving children of low to moderate income (67% were receiving Medicaid).
Of the 401 children, 342 (85%) had at least 1 risk factor for TB identified: 96 (24%) reported contact with persons who were considered to be at high risk for TB; 170 (42%) had at least 1 parent who was born in a high prevalence country; and 269 (67%) reported a household income of less than $15,500. Of the 401 children, 300 returned for TST interpretation, 257 (64%) by 48 to 72 hours and an additional 43 (11%) by 96 hours. Four (1.3%) of the 300 children had a positive TST (ie, induration > or = 10 mm). All 4 of the children who were TST positive had at least 1 parent from a high-risk country and were identified using AAP-defined risk criteria. The mean age of children who were TST positive was 15.3 years (range 13-17 years) compared with 8.1 years for those who were TST negative (P < .01). The positive predictive value of the questionnaire, which included income as a risk factor for TB, was only 1.5 (95% confidence interval = 0.5-4.0); when household income was not considered a risk factor, the positive predictive value was 2.0 (95% confidence interval = 0.7, 5.5). The estimated cost per child who was TST positive ranged from $430 for those who had contact with an incarcerated adult to $855 per child who was TST positive identified by using AAP-defined criteria.
The overall sensitivity of the AAP-defined criteria and having at least 1 parent from a TB-endemic country were high. However, because of the low prevalence of TB infection, the positive predictive value of these criteria was very low. These data support AAP recommendations only to skin test children who are at high risk for TB, but they also suggest that annual testing may not be cost-effective for many communities in the United States.
确定根据美国儿科学会（AAP）标准界定的结核病（TB）高危儿童比例、结核菌素皮肤试验（TST）结果判读随访的依从率以及TB感染率。
1994年4月13日至1994年8月30日，对401名12个月至18岁、在一家城市医院儿科门诊进行健康儿童检查的儿童开展了一项横断面研究。受访者完成一份自填式问卷，进行皮内TST，并预约在48至72小时后进行皮肤试验结果判读。
纽约州罗切斯特市一家以医院为基础的儿科初级保健中心，服务低收入至中等收入儿童（67%的儿童接受医疗补助）。
在401名儿童中，342名（85%）至少有1项TB危险因素：96名（24%）报告与被认为是TB高危人群有接触；170名（42%）至少有1名父母出生在TB高流行国家；269名（67%）报告家庭收入低于15,500美元。在401名儿童中，300名返回进行TST结果判读，257名（64%）在48至72小时后返回，另有43名（11%）在96小时后返回。300名儿童中有4名（1.3%）TST呈阳性（即硬结≥10毫米）。所有4名TST阳性儿童至少有1名父母来自高危国家，且是根据AAP定义的风险标准确定的。TST阳性儿童的平均年龄为15.3岁（范围13 - 17岁），而TST阴性儿童为8.1岁（P < .01）。将收入作为TB危险因素的问卷的阳性预测值仅为1.5（95%置信区间 = 0.5 - 4.0）；当家庭收入不被视为危险因素时，阳性预测值为2.0（95%置信区间 = 0.7, 5.5）。TST阳性儿童的估计成本从与被监禁成年人有接触的儿童每人430美元到根据AAP定义标准确定的TST阳性儿童每人855美元不等。
AAP定义的标准以及至少有1名父母来自TB流行国家的总体敏感性较高。然而，由于TB感染率较低，这些标准的阳性预测值非常低。这些数据支持AAP仅对TB高危儿童进行皮肤试验的建议，但也表明对于美国许多社区而言，年度检测可能不具有成本效益。
