Interpretation of the tuberculin skin test

Journal of General Internal Medicine
D N RoseJ J Adler

Abstract

To reinterpret epidemiologic information about the tuberculin test (purified protein derivative) in terms of modern approaches to test characteristics; to clarify why different cutpoints of induration should be used to define a positive test in different populations; and to calculate test characteristics of the intermediate-strength tuberculin skin test, the probability of Mycobacterium tuberculosis infection at various induration sizes, the area under the receiver operating characteristic (ROC) curve, and optimal cutpoints for positivity. Standard epidemiologic assumptions were used to distinguish M. tuberculosis-infected from -uninfected persons; also used were data from the U.S. Navy recruit and World Health Organization tuberculosis surveys; and Bayesian analysis. In the general U.S. population, the test's sensitivity is 0.59 to 1.0, the specificity is 0.95 to 1.0, and the positive predictive value is 0.44 to 1.0, depending on the cutpoint. Among tuberculosis patients, the sensitivity is nearly the same as in the general population; the positive predictive value is 1.0. The area under the ROC curve is 0.997. The probability of M. tuberculosis infection at each induration size varies widely, depending on the prevalence. The ...Continue Reading

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