Context Universal tuberculin skin testing of children has been shown to be costly
and inefficient. In response, several authorities have recommended targeted
screening based on epidemiological risk. In 1996, the New York City Department
of Health (NYCDOH) developed questions to identify children who require a
tuberculin skin test.
Objective To determine the sensitivity, specificity, and predictive validity of
the NYCDOH tuberculosis risk assessment questionnaire.
Design Prospective criterion standard study in which tuberculin skin tests
and the NYCDOH questionnaire were administered simultaneously between August
1996 and January 1998. Specific questions asked about contact with a tuberculosis
case, birth in or travel to endemic areas, regular contact with high-risk
adults, and human immunodeficiency virus infection in the child.
Setting Ambulatory clinic in South Bronx, New York, NY.
Participants Consecutive sample of 2920 children aged 1 to 18 years.
Main Outcome Measures Sensitivity, specificity, positive and negative predictive values of
the questionnaire, and odds ratio (OR) of reactive skin test results.
Results The NYCDOH questionnaire identified 413 children (14%) as having at
least 1 risk factor. Of these, 23 (5.6%) had a positive skin test result;
4 (0.16%) of the 2507 without risk factors had a positive result. Results
for the full NYCDOH questionnaire were sensitivity, 85.2%; specificity, 86.0%;
negative predictive value, 99.8%; positive predictive value, 5.4%; and OR,
35.2 (95% confidence interval, 12.1-102.4).
Conclusion The NYCDOH questionnaire is a valid instrument for identifying children
for tuberculin skin testing.