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Reliability of Tuberculin Skin Test Measurement

Jacques Pouchot, MD; Anne Grasland, MD; Carole Collet, MD; Joel Coste, MD, PhD; John M. Esdaile, MD, MPH; and Philippe Vinceneux, MD

1 February 1997 | Volume 126 Issue 3 | Pages 210-214

Background: Important management decisions depend on results of the tuberculin skin test. However, the test is subject to several potential errors, and its reliability has not been adequately studied.

Objective: To ascertain the reliability of tuberculin skin testing.

Design: Cross-sectional study.

Setting: University hospital.

Participants: 96 persons who received a tuberculin skin test.

Measurements: Ballpoint-pen and palpation measures of induration.

Results: Global intra- and interobserver reliability coefficients of the ballpoint-pen technique were high. Five percent of the time, however, a second measurement by the same observer could be at least 2.7 mm less to 3.0 mm more than the first measurement and the measurement from the second observer could be at least 3.4 mm less to 3.7 mm more than the measurement from the first observer. This could lead to the reclassification of a positive test result as negative or vice versa. The area of imprecision was 38% less broad for the ballpoint-pen technique than for the palpation technique.

Conclusion: Reading of tuberculin skin tests may frequently result in misclassifications when measurements are close to the cutoff point that separates negative from positive results.

Author and Article Information

From Hopital Louis Mourier, Colombes, France; Hopital Cochin, Paris, France; and Vancouver Hospital, Vancouver, British Columbia, Canada.
Acknowledgments: The authors thank Christine Chandemerle for her help in collecting the data.
Requests for Reprints: Jacques Pouchot, MD, Service de Medecine Interne V, Hopital Louis Mourier, 178 rue des Renouillers, 92700 Colombes, France.
Current Author Addresses: Drs. Pouchot, Grasland, Collet, and Vinceneux: Service de Medecine Interne V, Hopital Louis Mourier, 178 rue des Renouillers, 92700 Colombes, France.

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