Kendig E L, Kirkpatrick B V, Carter W H, Hill F A, Caldwell K, Entwistle M
Department of Pediatrics and Biostatistics, Medical College of Virginia, Virginia Commonwealth University, Richmond, USA.
Chest. 1998 May;113(5):1175-7. doi: 10.1378/chest.113.5.1175.
The tuberculin skin test is the best diagnostic method to detect tuberculous infection. How accurate is interpretation of the test?
Observational study.
Both general hospital and university hospital.
One hundred seven health-care professionals, including 52 practicing pediatricians, 33 pediatric house officers, 10 pediatric academicians, 11 registered nurses, and 1 pediatric nurse practitioner.
A tuberculin skin test (Mantoux) was applied to the arm of a known tuberculin converter. As participants entered/left the room, they were guided to the tuberculin converter. At no time did a participant observe readings other than his/her own.
Mantoux tuberculin reaction measuring 15 mm induration was read individually by a group of 52 practicing pediatricians, 33 pediatric house officers, 10 pediatric academicians, 11 registered nurses, and one pediatric nurse practitioner. The median induration recorded by this group of 107 health-care professionals was 10 mm, and 17 (33%) practicing pediatricians read the reaction as <10 mm induration. Using the > or = 15-mm induration indicator to identify a positive reaction, 93% of those in the study (99/107 participants) would have identified our known converter as tuberculin negative.
This study confirms a general inaccuracy in interpretation of the tuberculin skin test reaction. It raises two questions. (1) Is there a general tendency toward underreading? (2) Does this general tendency to underread tuberculin skin test reactions raise some question as to the American Academy of Pediatrics, American Thoracic Society, and Centers for Disease Control and Prevention move in raising the amount of induration considered tuberculin positive to 15 mm in low-risk individuals?
结核菌素皮肤试验是检测结核感染的最佳诊断方法。该试验结果的解读准确性如何？
观察性研究。
综合医院和大学医院。
107名医护人员，包括52名执业儿科医生、33名儿科住院医师、10名儿科院士、11名注册护士和1名儿科执业护士。
对一名已知结核菌素阳转者的手臂进行结核菌素皮肤试验（曼托试验）。当参与者进入/离开房间时，他们被引导至结核菌素阳转者处。参与者在任何时候都只观察自己的试验结果。
一组52名执业儿科医生、33名儿科住院医师、10名儿科院士、11名注册护士和1名儿科执业护士分别对曼托试验中硬结直径为15毫米的反应进行了判读。这107名医护人员记录的硬结直径中位数为10毫米，17名（33%）执业儿科医生将该反应判读为硬结直径<10毫米。使用硬结直径≥15毫米作为判断阳性反应的指标，研究中的93%（99/107名参与者）会将我们已知的阳转者判读为结核菌素阴性。
本研究证实了结核菌素皮肤试验反应解读普遍存在不准确的情况。这引发了两个问题。（1）是否存在普遍的判读不足倾向？（2）这种对结核菌素皮肤试验反应普遍判读不足的倾向是否对美国儿科学会、美国胸科学会以及美国疾病控制与预防中心将低风险个体中结核菌素阳性的硬结直径判定标准提高到15毫米的举措提出了一些质疑？
