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Tuberculin Skin Testing
- Jenice N. Longfield, MD, MPH;
- Andrew M. Margileth, MD; and
- David F. Cruess, PhD
- 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
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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.
Jenice N. Longfield, MD, MPH
Brooke Army Medical Center; San Antonio, TX 78234-6226
Andrew M. Margileth, MD
Mercer School of Medicine; Hilton Head, SC 29925
David F. Cruess, PhD
Uniformed Services University of the Health Sciences; Bethesda, MD 20814
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
