title: To x-ray or not to x-ray? Screening asymptomatic children for pulmonary TB: a retrospective audit.
abstract: OBJECTIVE
  Recent studies found that a chest x-ray (CXR) has limited value in the assessment of asymptomatic adults with tuberculosis (TB) infection. We aimed to determine in asymptomatic children with a positive tuberculin skin test and/or interferon-γ release assay (TST/IGRA) whether a CXR identifies findings suggestive of pulmonary TB.
  
  
  METHODS
  All children with TB infection (defined as TST ≥10 mm and/or positive IGRA) presenting to The Royal Children's Hospital Melbourne during a 54-month period were included. All CXRs were reviewed by a senior radiologist blinded to the clinical details. The medical records of those with radiological abnormalities suggestive of TB were examined to identify those who were asymptomatic when the CXR was done. Demographical data were also collected.
  
  
  RESULTS
  CXRs were available for 268 of 330 TB-infected children, of whom 60 had CXR findings suggestive of TB. Of the 57 for whom clinical details were available, 26 were asymptomatic. Of these asymptomatic children with radiological abnormalities suggestive of TB, 6 had CXR findings suggestive of active TB, 14 had CXR findings suggestive of prior TB and 6 had isolated non-calcified hilar lymphadenopathy. The six with findings suggestive of active TB represented 2.6% (95% CI 0.9 to 5.5%) of asymptomatic TST/IGRA-positive children with evaluable CXRs. One child with isolated hilar lymphadenopathy had microbiologically-confirmed TB.
  
  
  CONCLUSIONS
  In contrast to the results from studies in adults, a CXR identified a small but noteworthy number of children with findings suggestive of pulmonary TB in the absence of clinical symptoms.
authors.affiliation: Infectious Diseases Unit, Department of General Medicine, The Royal Children’s Hospital Melbourne, Parkville Victoria, Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Gwee
authors.forename: Anastasia
authors.initials: A
authors.lastname: Pantazidou
authors.forename: Nicole
authors.initials: N
authors.lastname: Ritz
authors.forename: Marc
authors.initials: M
authors.lastname: Tebruegge
authors.forename: Tom G
authors.initials: TG
authors.lastname: Connell
authors.forename: Tim
authors.initials: T
authors.lastname: Cain
authors.forename: Nigel
authors.initials: N
authors.lastname: Curtis
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D059425:Interferon-gamma Release Tests / Q000379:methods; D008403:Mass Screening / Q000379:methods*; D013902:Radiography, Thoracic / Q000379:methods; D012189:Retrospective Studies; D014374:Tuberculin Test / Q000379:methods; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging*; D014739:Victoria
keywords: General Paediatrics; Infectious Diseases