Self-Assessment of Tuberculin Skin Test Reactions by New York City Firelighters

Reliability and Cost-Effectiveness in an Occupational Health Care Setting

David J. Prezant, Kerry J. Kelly, Manoj Lal Karwa, Kathryn Kavanagh

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective: To determine whether self-assessment of purified protein derivative of tuberculin (PPD) skin test reactions, done using a simple two-choice approach, is an effective screening method for tuberculosis. Design: Double-blind comparison between self-assessments and trained professional readings of PPD skin test reactions, done 72 hours after test administration. Setting: The New York City Fire Department's Bureau of Health Services Participants: 2011 New York City firefighters and fire officers were given PPD skin tests during a mandatory retraining course. Thirty-seven persons were excluded because of a history of a positive PPD skin test result or a bacille Calmette-Guérin vaccination. All others agreed to participate in testing and self-assessment done using simple written instructions. Self-assessment results were submitted just before trained professional readings were done. Measurements: Self-assessments and trained professional readings of PPD skin test reactions. Results: 1833 participants (91%) interpreted their test reactions as flat. Of these interpretations, 1824 (99.5%) matched the professional reading and 9 (0.5%) did not. One hundred seventy-eight participants (9%) interpreted their test reactions as not flat; 136 of these interpretations (76.4%) matched the professional reading and 42 (23.6%) did not (κ = 0.828; lower 95% confidence limit = 0.790). The predictive value of a negative self-assessment reading was 99.5%, and the specificity was 97.7%. Conclusion: In this occupational health care setting, we follow (and recommend to others with similar populations) a tuberculin screening program based on self-assessment. Repeated tests with follow-up are required for all persons who do not report their results. All persons with self-assessments of "not flat" should return for readings by trained professionals, counseling, and treatment.

Original languageEnglish (US)
Pages (from-to)280-283
Number of pages4
JournalAnnals of Internal Medicine
Volume125
Issue number4
StatePublished - Aug 15 1996

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Tuberculin Test
Occupational Health
Skin Tests
Cost-Benefit Analysis
Tuberculin
Reading
Delivery of Health Care
Firefighters
Self-Assessment
Health Services
Counseling
Vaccination
Tuberculosis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{5bf2780a5bc1474c9a8a451e5c8a75ff,
title = "Self-Assessment of Tuberculin Skin Test Reactions by New York City Firelighters: Reliability and Cost-Effectiveness in an Occupational Health Care Setting",
abstract = "Objective: To determine whether self-assessment of purified protein derivative of tuberculin (PPD) skin test reactions, done using a simple two-choice approach, is an effective screening method for tuberculosis. Design: Double-blind comparison between self-assessments and trained professional readings of PPD skin test reactions, done 72 hours after test administration. Setting: The New York City Fire Department's Bureau of Health Services Participants: 2011 New York City firefighters and fire officers were given PPD skin tests during a mandatory retraining course. Thirty-seven persons were excluded because of a history of a positive PPD skin test result or a bacille Calmette-Gu{\'e}rin vaccination. All others agreed to participate in testing and self-assessment done using simple written instructions. Self-assessment results were submitted just before trained professional readings were done. Measurements: Self-assessments and trained professional readings of PPD skin test reactions. Results: 1833 participants (91{\%}) interpreted their test reactions as flat. Of these interpretations, 1824 (99.5{\%}) matched the professional reading and 9 (0.5{\%}) did not. One hundred seventy-eight participants (9{\%}) interpreted their test reactions as not flat; 136 of these interpretations (76.4{\%}) matched the professional reading and 42 (23.6{\%}) did not (κ = 0.828; lower 95{\%} confidence limit = 0.790). The predictive value of a negative self-assessment reading was 99.5{\%}, and the specificity was 97.7{\%}. Conclusion: In this occupational health care setting, we follow (and recommend to others with similar populations) a tuberculin screening program based on self-assessment. Repeated tests with follow-up are required for all persons who do not report their results. All persons with self-assessments of {"}not flat{"} should return for readings by trained professionals, counseling, and treatment.",
author = "Prezant, {David J.} and Kelly, {Kerry J.} and Karwa, {Manoj Lal} and Kathryn Kavanagh",
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T1 - Self-Assessment of Tuberculin Skin Test Reactions by New York City Firelighters

T2 - Reliability and Cost-Effectiveness in an Occupational Health Care Setting

AU - Prezant, David J.

AU - Kelly, Kerry J.

AU - Karwa, Manoj Lal

AU - Kavanagh, Kathryn

PY - 1996/8/15

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N2 - Objective: To determine whether self-assessment of purified protein derivative of tuberculin (PPD) skin test reactions, done using a simple two-choice approach, is an effective screening method for tuberculosis. Design: Double-blind comparison between self-assessments and trained professional readings of PPD skin test reactions, done 72 hours after test administration. Setting: The New York City Fire Department's Bureau of Health Services Participants: 2011 New York City firefighters and fire officers were given PPD skin tests during a mandatory retraining course. Thirty-seven persons were excluded because of a history of a positive PPD skin test result or a bacille Calmette-Guérin vaccination. All others agreed to participate in testing and self-assessment done using simple written instructions. Self-assessment results were submitted just before trained professional readings were done. Measurements: Self-assessments and trained professional readings of PPD skin test reactions. Results: 1833 participants (91%) interpreted their test reactions as flat. Of these interpretations, 1824 (99.5%) matched the professional reading and 9 (0.5%) did not. One hundred seventy-eight participants (9%) interpreted their test reactions as not flat; 136 of these interpretations (76.4%) matched the professional reading and 42 (23.6%) did not (κ = 0.828; lower 95% confidence limit = 0.790). The predictive value of a negative self-assessment reading was 99.5%, and the specificity was 97.7%. Conclusion: In this occupational health care setting, we follow (and recommend to others with similar populations) a tuberculin screening program based on self-assessment. Repeated tests with follow-up are required for all persons who do not report their results. All persons with self-assessments of "not flat" should return for readings by trained professionals, counseling, and treatment.

AB - Objective: To determine whether self-assessment of purified protein derivative of tuberculin (PPD) skin test reactions, done using a simple two-choice approach, is an effective screening method for tuberculosis. Design: Double-blind comparison between self-assessments and trained professional readings of PPD skin test reactions, done 72 hours after test administration. Setting: The New York City Fire Department's Bureau of Health Services Participants: 2011 New York City firefighters and fire officers were given PPD skin tests during a mandatory retraining course. Thirty-seven persons were excluded because of a history of a positive PPD skin test result or a bacille Calmette-Guérin vaccination. All others agreed to participate in testing and self-assessment done using simple written instructions. Self-assessment results were submitted just before trained professional readings were done. Measurements: Self-assessments and trained professional readings of PPD skin test reactions. Results: 1833 participants (91%) interpreted their test reactions as flat. Of these interpretations, 1824 (99.5%) matched the professional reading and 9 (0.5%) did not. One hundred seventy-eight participants (9%) interpreted their test reactions as not flat; 136 of these interpretations (76.4%) matched the professional reading and 42 (23.6%) did not (κ = 0.828; lower 95% confidence limit = 0.790). The predictive value of a negative self-assessment reading was 99.5%, and the specificity was 97.7%. Conclusion: In this occupational health care setting, we follow (and recommend to others with similar populations) a tuberculin screening program based on self-assessment. Repeated tests with follow-up are required for all persons who do not report their results. All persons with self-assessments of "not flat" should return for readings by trained professionals, counseling, and treatment.

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