LETTER
Tuberculin Skin Testing
Jenice N. Longfield, MD, MPH;
Andrew M. Margileth, MD; and
David F. Cruess, PhD
15 August 1997 | Volume 127 Issue 4 | Page 334
TO THE EDITOR:
We agree with Pouchot and colleagues [1] that the reliability and validity of the method used to read tuberculin skin tests have important implications for clinical decision making. We addressed this issue and published a similar study in 1984 that compared the ballpoint and palpation method used by five raters of 101 participants [2]. This article included a picture of the ballpoint method that may be useful to readers. We found excellent interobserver agreement for both techniques. Variability due to the method of reading was examined for each reader by using the coefficient of variation, as suggested by Pouchot and colleagues: three of the five readers in our study had more variation when using the palpation technique. If 10 mm of induration is considered a positive result, the measurement technique would have affected the clinical interpretation of the result in less than 7% of patients. Our study did not address errors in intraobsever reading that were independent of the method used. Pouchot and colleagues' suggestion of averaging two readings by the same reader to improve intraobserver reliability is reasonable. Adequacy of training with which to teach methods of skin test reading is especially important in this era of increased prevalence of tuberculosis and emergence of multidrug-resistant tuberculosis.
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Author and Article Information
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Brooke Army Medical Center; San Antonio, TX 78234-6226
Mercer School of Medicine; Hilton Head, SC 29925
Uniformed Services University of the Health Sciences; Bethesda, MD 20814
1. Pouchot J, Grasland A, Collet C, Coste J, Esdaile JM, Vincenaux P. Reliability of tuberculin skin test measurement. Ann Intern Med. 1997; 126:210-4.
2. Longfield JN, Margileth AM, Golden SM, Lazoritz S, Bohan JS, Cruess DF. Interobserver and method variability in tuberculin skin testing. Pediatr Infect Dis. 1984; 3:323-6.
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