Collaboration with school nurses: Improving the effectiveness of tuberculosis screening

Objective: To compare tuberculosis skin test (TST) reading rates between children whose tests were read by school nurses following specific requests by physicians and those who relied on their parents to get their tests read, either at school or at the physician's office. Design: A randomized controlled trial. Setting: An urban hospital-based pediatric practice. Participants: Healthy low-income Hispanic and African American children aged 5 to 17 years whose physicians ordered TSTs at their routine physical examinations. Subjects attended 1 of 68 public schools. Nurses at these schools were willing to read student TSTs, and received instructions about how to read and report the results back to the physician's office. Intervention: Subjects were randomized to a control group (routine TST placement, with no physician-to-school nurse communication) or to an intervention group (routine TST placement, with physician-to-school nurse communication). Main Outcome Measures: Tuberculosis skin test reading rates between the 2 groups were compared. Impediments to TST reading and reporting were investigated. Results: One hundred thirty-four children were enrolled, 54 (40%) in the control group and 80 (60%) in the intervention group. More patients in the intervention group had their TSTs read by 72 hours compared with those in the control group (74 [92%] vs 30 [56%]; P<.001). The low reading rate in the control group was best attributed to communication failures. Conclusion: Systematic collaboration with school nurses can increase TST reading rates.