Tuberculin screening of trauma admissions at a university hospital. A preventive strategy
R. Taneja, S. Merritt, S. Vanek, M. Passannante and D. H. Livingston
Department of Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, USA.
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.
