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Education, Teaching, and Quality Improvement |

Targeted Testing for Latent Tuberculosis: How Much Do We Know?

Rajany Dy; Lynn Tanoue
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Yale New Haven Hospital, Hamden, CT


Chest. 2014;146(4_MeetingAbstracts):528A. doi:10.1378/chest.1988066
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Abstract

SESSION TITLE: Quality & Clinical Improvement Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Significant progress has been made toward the elimination of tuberculosis (TB) in the United States. Since the number of active TB cases has steadily decreased, focus has shifted to the identification and treatment of latent TB infection (LTBI). This project was performed with the intent of assessing and improving resident knowledge relating to LTBI, emphasizing recognition of patients who warrant screening, and utilization of appropriate screening tests in specific clinical situations.

METHODS: A survey was developed using case vignettes representing patient groups at varying risks for LTBI. The survey was implemented in the context of peer teaching in the Yale Internal Medicine residency programs. Five clinical cases were described, and a 15-point questionnaire was administered to assess resident knowledge. After completion of surveys, a 30-minute lecture on LTBI was delivered, discussing the current ATS/CDC guidelines and addressing the specific vignettes.

RESULTS: 61 Internal Medicine residents (PGY1-PGY3) were surveyed. The following questions were asked for each vignette: a. Does the patient warrant LTBI screening? b. If yes, is TST or Quantiferon the preferred test? c. If TST were chosen, what cut-off level would define a positive test? Based on the ATS/CDC criteria for LTBI screening, 4 vignettes (case 1, 3, 4 and 5) warranted TB testing; these were correctly identified by 86%, 86%, 54% and 86% of residents, respectively. Appropriate cut-off levels for positive TST were identified by 62%, 58%, 67% and 83% of residents, respectively. In case 1 and 3, in which Quantiferon was the recommended test of choice, 5% and 28% of residents answered correctly. In case 2, in which the risk for LTBI was too low to warrant screening, 38% of residents indicated they would have tested the patient. Across the 5 clinical cases, the range of identification of appropriate cut-off thresholds defining a positive TST was 37-83%.

CONCLUSIONS: Internal medicine residents need education relating to targeted testing for LTBI. This includes the recognition of susceptible populations, the differences between the two widely available screening methods (TST and Quantiferon), the situations in which one test should preferentially be used, and the appropriate cut-off levels for a positive TST in different patient settings.

CLINICAL IMPLICATIONS: Education could promote improved screening of populations at risk for LTBI, prevent unnecessary testing of low-risk populations, and limit unnecessary use of more expensive screening methods.

DISCLOSURE: The following authors have nothing to disclose: Rajany Dy, Lynn Tanoue

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