Evaluation of a tuberculosis screening program at a children's hospital

Routine screening of patients for tuberculosis at the time of hospitalization and annual screening of hospital employees continue to be controversial. No data are available concerning tuberculosis screening programs at pediatric facilities. We reviewed the results of patient and employee tuberculosis screening programs in the last decade at the Izaak Walton Killam Hospital for Children. Four (11%) of 37 cases of tuberculosis were unsuspected until identified by the routine screening of all children at their admission to the hospital. No cases of tuberculosis were identified as a result of the employee screening program. Compliance with both screening programs was less than optimal. Review of programs at other Canadian pediatric centers demonstrated a range of practice. We conclude that routine screening of patients at the time of admission to the hospital and the annual screening of employees are unwarranted at present at our children's hospital. However, discontinuation of routine testing necessitates aggressive contact-tracing by public health authorities of patients with identified cases and periodic reevaluation of costs and benefits to determine whether reintroduction of screening is appropriate.