Evaluation of a risk assessment questionnaire used to target tuberculin skin testing in children

Context Universal tuberculin skin testing of children has been shown to be costly and inefficient. In response, several authorities have recommended t argeted 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 validit y 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 Augus t 1996 and January 1998, Specific questions asked about contact with a tube rculosis case, birth in or travel to endemic areas, regular contact with hi gh-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 predi ctive values of the questionnaire, and odds ratio (OR) of reactive skin tes t 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 f or the full NYCDOH questionnaire were sensitivity, 85.2%; specificity, 86.0 %; negative predictive value, 99.8%; positive predictive value, 5.4%; and O R, 35.2 (95% confidence interval, 12.1-102.4), Conclusion The NYCDOH questionnaire is a valid instrument for identifying c hildren for tuberculin skin testing.