Comparison of different methods and times for reading the tuberculin skin test

摘要

BACKGROUND: Current guidelines vary on the recommended method and time for measuring tuberculin skin test (TST) indurations. OBJECTIVE: To evaluate the best time and method for assessing TST results and which purified protein derivative (PPD) to administer. DESIGN: Standard PPD (PPD-S) and PPD-RT23 were applied concurrently on each forearm in random order in 78 nurses. MEASUREMENTS: TST induration was measured at 48, 72 and 96 h by two nurses by palpation and a ruler, palpation and a Vernier caliper, ballpoint pen and a ruler or ballpoint pen and a Vernier caliper. TST differences were assessed using mixed-effects analysis. We also assessed the rate of false-positive/-negative results and the variability of the TST measurements. RESULTS: We performed 767 TST measurements. The adjusted mean TST size was larger with PPD-S than with PPD-RT23 (12.8 vs. 10.8 mm, P < 0.001), and at 72 h than at 48 h and 96 h (13.4 vs. 11.8 vs. 10.1 mm, P < 0.05). The smallest number of false results was observed with PPD-S, the ballpoint pen-ruler and at 72 h; palpation+ruler had the least variability at 72 h. CONCLUSIONS: The TST should ideally be performed with PPD-S and measured at 72 h with the ballpoint pen+ruler or palpation+ruler methods.