Tuberculosis testing. Physician attitudes and practice
T. L. Cheng, E. B. Miller, M. Ottolini, C. Brasseux and G. Rosenquist
Department of General Pediatrics, Children's National Medical Center, George Washington University, Washington, DC, USA.
OBJECTIVE: To assess physician agreement with and adoption of American
Academy of Pediatrics' (AAP) recommendations on tuberculosis screening in
children. DESIGN AND PARTICIPANTS: 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.
RESULTS: 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. CONCLUSIONS: 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.
