title: Tuberculin skin test and Quantiferon test agreement and influencing factors in tuberculosis screening of healthcare workers: a systematic review and meta-analysis.
abstract: OBJECTIVE
  A systematic review and meta-analysis was conducted to evaluate the agreement between Tuberculin Skin Test (TST) and Quantiferon (QFT) in screening for tuberculosis (TB) infection among healthcare workers (HCWs) and to estimate associations between TST and QFT agreement and variables of interest, such as Bacillus Calmette-Guérin (BCG) vaccination and incidence of TB.
  
  
  METHODS
  Cross-sectional and longitudinal studies on HCWs, published in English until October 2013, comparing TST and QFT results, were selected. For each study Cohen's κ value and a 95% confidence interval were calculated. Summary measures and indexes of heterogeneity between studies were calculated.
  
  
  RESULTS
  29 studies were selected comprising a total of 11,434 HCWs. Cohen's κ for agreement between TST and QFT for 24 of them was 0.28 (95% CI 0.22 to 0.35), with the best value in high TB incidence countries and the lowest rate of BCG vaccination.
  
  
  CONCLUSIONS
  Currently, there is no gold standard for TB screening and the most-used diagnostic tools show low agreement. For evidence-based health surveillance in HCWs, occupational physicians need to consider a number of factors influencing screening results, such as TB incidence, vaccination status, age and working seniority.
authors: Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy.
authors: Monica
authors: M
authors: Lamberti
authors: Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy.
authors: Rossella
authors: R
authors: Uccello
authors: Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy.
authors: Maria Grazia Lourdes
authors: MGL
authors: Monaco
authors: Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy.
authors: Mariarosaria
authors: M
authors: Muoio
authors: Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy.
authors: Daniela
authors: D
authors: Feola
authors: Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy.
authors: Nicola
authors: N
authors: Sannolo
authors: Center of Excellence for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Service Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.|Principles of Prevention and Rehabilitation Department (GPR), Institute for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany.
authors: Albert
authors: A
authors: Nienhaus
authors: Medical Statistics Unit, Second University of Naples, Naples, Italy.
authors: Paolo
authors: P
authors: Chiodini
keywords: Cohen’s k; Health surveillance; Healthcare workers; Meta-analysis; Quantiferon TB Gold; Tuberculin skin test; Tuberculosis