Missed opportunities for tuberculosis screening in primary care

Area of Science:

• Pediatrics
• Infectious Diseases
• Public Health

Background:

• Latent tuberculosis infection (LTBI) screening is crucial for early detection and treatment in children.
• Guidelines exist for LTBI screening in pediatric primary care settings.
• Previous studies suggest potential disparities in healthcare delivery based on parent language.

Purpose of the Study:

• To evaluate the frequency of LTBI screening among pediatric patients according to established guidelines.
• To investigate the association between parent primary language and LTBI screening practices.
• To identify potential barriers or gaps in LTBI screening and documentation.

Main Methods:

• Retrospective cohort study of well-child visits in an urban academic pediatric clinic (April 2012–March 2013).
• Assessment of documentation for three LTBI screening components.
• Analysis of the relationship between parent primary language and tuberculin skin test (TST) placement and results documentation.

Main Results:

• Of 8756 children assessed, 10% were high-risk for LTBI, and 62% of these lacked documented TST placement.
• 18% of children with TST placement had undocumented results.
• Parent language was not associated with TST placement or results documentation; however, non-Hispanic Black children had higher odds of undocumented TST results.

Conclusions:

• Significant deficiencies exist in LTBI screening and TST results documentation for high-risk children.
• Race/ethnicity, not parent primary language, was associated with incomplete documentation of TST results.
• Quality improvement initiatives are needed to ensure comprehensive LTBI screening in high-risk pediatric populations.