title: Missed opportunities for tuberculosis screening in primary care.
abstract: OBJECTIVE
  To assess how frequently pediatric practitioners perform latent tuberculosis infection (LTBI) screening according to guidelines. We hypothesized that screening occurs less frequently among children whose parents do not speak English as the primary language.
  
  
  METHODS
  We conducted a retrospective cohort study of patients attending well-child visits in an urban academic pediatric primary care clinic between April 1, 2012, and March 31, 2013. We assessed documentation of 3 LTBI screening components and tested the association between parent primary language and tuberculin skin test (TST) placement and documentation of results.
  
  
  RESULTS
  During the study period, 387 of 9143 children (4%) had no documentation of screening question responses. Among the other 8756 children, 831 (10%) were identified as at high risk for LTBI. Of these, 514 (62%) did not have documented TST placement in the appropriate time frame. Thirty-nine of 213 children (18%) who had a TST placed did not have documented results. Multivariable regression showed that parent language was not associated with TST placement or documentation of results, but non-Hispanic Black children were more likely to not have a documented test result (aOR, 2.12; 95% CI, 1.07-4.19; P=.03) when adjusting for age, sex, parent primary language, insurance status, day of the week, and study year of TST placement.
  
  
  CONCLUSIONS
  Parent primary language was not associated with LTBI testing. However, we found substantial gaps in TST placement and documentation of TST results among high-risk children, the latter of which was associated with race/ethnicity. Targeted quality improvement efforts should focus on developing processes to ensure complete screening in high-risk children.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. Electronic address: yuri.vanderheijden@vanderbilt.edu.
authors.forename: Yuri F
authors.initials: YF
authors.lastname: van der Heijden
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: William J
authors.initials: WJ
authors.lastname: Heerman
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Sara
authors.initials: S
authors.lastname: McFadden
authors.affiliation: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Yuwei
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Barron L
authors.initials: BL
authors.lastname: Patterson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007223:Infant; D055985:Latent Tuberculosis / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D015999:Multivariate Analysis; D011320:Primary Health Care / Q000379:methods*; D012189:Retrospective Studies; D013714:Tennessee; D014374:Tuberculin Test