Future direction of tuberculin skin test: Integration of telemedicine for test reading

The Tuberculin Skin Test (TST) remains an important tool for the diagnosis of tuberculosis infection (TBI), including in patients receiving immunomodulatory therapies. However, conventional in-person TST reading requires repeated hospital visits, which may pose logistical challenges and limit accessibility to care. This study aimed to evaluate the reliability of patient self-assessment of TST reactions under real-time telemedicine supervision.

This prospective observational study included 100 adult patients with an indication for TST. After purified protein derivative (PPD) administration, all participants received standardized educational materials and a uniform measurement protocol. At 72 h, patients performed self-measurement of TST induration during real-time video consultations under physician guidance. Immediately thereafter, TST measurements were repeated in the outpatient clinic by a pulmonologist for comparison.

A statistically significant moderate agreement was observed between patient- and physician-measured induration diameters (κ = 0.535, p < 0.001). Among patients with physician-assessed TST-negative results, concordance with self-assessment was high, including 97% of patients receiving immunomodulatory treatment. Clinically relevant discordance requiring protocol modification was observed in 8% of cases and occurred predominantly among patients reporting measurable induration.

Telemedicine-supported TST assessment demonstrates acceptable reliability and may serve as a practical alternative to conventional in-person evaluation, particularly for patients with TST-negative results. This approach has the potential to reduce unnecessary hospital visits and optimize healthcare resource utilization. Further studies are warranted to better define patient subgroups that may benefit from in-person confirmation.