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Tuberculin Screening of Trauma Admissions at a University Hospital: A Preventive Strategy

Tuberculin Screening of Trauma Admissions at a University Hospital: A Preventive Strategy Abstract Objective: To determine the prevalence of tuberculosis (TB) infection in our trauma service population, namely, those patients who had positive Mantoux (purified protein derivative [PPD] [tuberculin]) tests. Design: Prospective study. Setting: Trauma service at a university hospital in Newark, NJ. Patients and Methods: During a 9-month period, 110 admitted trauma patients underwent screening for TB. Of these patients, 20 had undergone recent PPD tests in the last 6 months, of which nine were positive. The remaining 90 patients underwent PPD and delayed-type hypersensitivity skin tests (anergy panel); five patients were unavailable for follow-up. The patients also answered questions regarding human immunodeficiency virus status, risk factors for TB infection, and clinical symptoms. Results: The mean age of the study group was 34 years (age range, 13 to 69 years). Eighty-four percent of these patients were males who belonged to the high-risk socioeconomic, racial, and ethnic groups (poor, non-white). The tests for 15 patients (17%) were newly discovered to be positive for PPD. Eleven percent of the patients with negative PPD tests were anergic, thus raising the percentage of patients with positive PPD tests to 20%. The human immunodeficiency virus status was known in only 41% of the total patients. All patients with positive PPD tests had a chest x-ray film performed; of these patients, positive findings for TB were determined for one patient. Another patient had evidence of abdominal TB at laparotomy. All patients with positive PPD tests were given appointments in the pulmonary clinic for follow-up, and only three of 15 patients kept their appointments. Conclusions: Patients who were admitted to the trauma service were predominantly young males from high-risk groups with a high incidence of TB infection. Their admission to the trauma service was a unique opportunity for screening and implementing existing preventive programs.(Arch Surg. 1995;130:1223-1227) References 1. Cantwell MF, Snider DE, Cauthen GM, Onorato IM. Epidemiology of tuberculosis in the United States, 1985 through 1992 . JAMA . 1994:272:535-539.Crossref 2. Brudney K, Dobkin J. Resurgent tuberculosis in New York City: human immunodeficiency virus, homelessness and the decline of tuberculosis control programs . Am Rev Respir Dis . 1991:144:745-749.Crossref 3. Centers for Disease Control and Prevention. Core Curriculum on Tuberculosis: What the Clinician Should Know . 3rd ed. Atlanta, Ga: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, US Dept of Health and Human Services; 1994. 4. Huebner RE, Schein MF, Bass JB Jr. The tuberculin skin test . Clin Infect Dis . 1993;17:968-975.Crossref 5. Bass JB Jr. Tuberculin test, preventive therapy and elimination of tuberculosis . Am Rev Respir Dis . 1990;141:812-813.Crossref 6. Centers for Disease Control and Prevention. A strategic plan for the elimination of tuberculosis in the United States . MMWR Morb Mortal Wkly Rep . 1989; 38( (suppl S-3) ):1-25. 7. Centers for Disease Control and Prevention. Screening for tuberculosis and tuberculosis infection in high-risk populations: recommendations of the Advisory Committee for the Elimination of Tuberculosis . MMWR Morb Mortal Wkly Rep . 1990;39( (RR8) ):1-7. 8. Centers for Disease Control and Prevention. Prevention and control of tuberculosis in U.S. communities with at-risk minority populations: recommendations of the Advisory Committee for the Elimination of Tuberculosis . MMWR Morb Mortal Wkly Rep . 1992;41( (RR5) ):1-12. 9. Centers for Disease Control and Prevention. Emerging infectious diseases: tuberculosis morbidity–United States, 1992 . MMWR Morb Mortal Wkly Rep . 1993; 42( (36) ):696-700. 10. Centers for Disease Control and Prevention. Tuberculosis among foreign-born persons entering the United States: recommendations of the Advisory Committee for the Elimination of Tuberculosis . MMWR Morb Mortal Wkly Rep . 1990; 39( (RR18) ):1-21. 11. Jordan TJ, Lewit EM, Reichman LB. Isoniazid preventive therapy for tuberculosis: decision analysis considering ethnicity and gender . Am Rev Respir Dis . 1991;144:1357-1360.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Tuberculin Screening of Trauma Admissions at a University Hospital: A Preventive Strategy

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References (15)

Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1995.01430110081015
Publisher site
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Abstract

Abstract Objective: To determine the prevalence of tuberculosis (TB) infection in our trauma service population, namely, those patients who had positive Mantoux (purified protein derivative [PPD] [tuberculin]) tests. Design: Prospective study. Setting: Trauma service at a university hospital in Newark, NJ. Patients and Methods: During a 9-month period, 110 admitted trauma patients underwent screening for TB. Of these patients, 20 had undergone recent PPD tests in the last 6 months, of which nine were positive. The remaining 90 patients underwent PPD and delayed-type hypersensitivity skin tests (anergy panel); five patients were unavailable for follow-up. The patients also answered questions regarding human immunodeficiency virus status, risk factors for TB infection, and clinical symptoms. Results: The mean age of the study group was 34 years (age range, 13 to 69 years). Eighty-four percent of these patients were males who belonged to the high-risk socioeconomic, racial, and ethnic groups (poor, non-white). The tests for 15 patients (17%) were newly discovered to be positive for PPD. Eleven percent of the patients with negative PPD tests were anergic, thus raising the percentage of patients with positive PPD tests to 20%. The human immunodeficiency virus status was known in only 41% of the total patients. All patients with positive PPD tests had a chest x-ray film performed; of these patients, positive findings for TB were determined for one patient. Another patient had evidence of abdominal TB at laparotomy. All patients with positive PPD tests were given appointments in the pulmonary clinic for follow-up, and only three of 15 patients kept their appointments. Conclusions: Patients who were admitted to the trauma service were predominantly young males from high-risk groups with a high incidence of TB infection. Their admission to the trauma service was a unique opportunity for screening and implementing existing preventive programs.(Arch Surg. 1995;130:1223-1227) References 1. Cantwell MF, Snider DE, Cauthen GM, Onorato IM. Epidemiology of tuberculosis in the United States, 1985 through 1992 . JAMA . 1994:272:535-539.Crossref 2. Brudney K, Dobkin J. Resurgent tuberculosis in New York City: human immunodeficiency virus, homelessness and the decline of tuberculosis control programs . Am Rev Respir Dis . 1991:144:745-749.Crossref 3. Centers for Disease Control and Prevention. Core Curriculum on Tuberculosis: What the Clinician Should Know . 3rd ed. Atlanta, Ga: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, US Dept of Health and Human Services; 1994. 4. Huebner RE, Schein MF, Bass JB Jr. The tuberculin skin test . Clin Infect Dis . 1993;17:968-975.Crossref 5. Bass JB Jr. Tuberculin test, preventive therapy and elimination of tuberculosis . Am Rev Respir Dis . 1990;141:812-813.Crossref 6. Centers for Disease Control and Prevention. A strategic plan for the elimination of tuberculosis in the United States . MMWR Morb Mortal Wkly Rep . 1989; 38( (suppl S-3) ):1-25. 7. Centers for Disease Control and Prevention. Screening for tuberculosis and tuberculosis infection in high-risk populations: recommendations of the Advisory Committee for the Elimination of Tuberculosis . MMWR Morb Mortal Wkly Rep . 1990;39( (RR8) ):1-7. 8. Centers for Disease Control and Prevention. Prevention and control of tuberculosis in U.S. communities with at-risk minority populations: recommendations of the Advisory Committee for the Elimination of Tuberculosis . MMWR Morb Mortal Wkly Rep . 1992;41( (RR5) ):1-12. 9. Centers for Disease Control and Prevention. Emerging infectious diseases: tuberculosis morbidity–United States, 1992 . MMWR Morb Mortal Wkly Rep . 1993; 42( (36) ):696-700. 10. Centers for Disease Control and Prevention. Tuberculosis among foreign-born persons entering the United States: recommendations of the Advisory Committee for the Elimination of Tuberculosis . MMWR Morb Mortal Wkly Rep . 1990; 39( (RR18) ):1-21. 11. Jordan TJ, Lewit EM, Reichman LB. Isoniazid preventive therapy for tuberculosis: decision analysis considering ethnicity and gender . Am Rev Respir Dis . 1991;144:1357-1360.Crossref

Journal

Archives of Surgery – American Medical Association

Published: Nov 1, 1995

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