All Children with Positive TB Screening Tests Need a Chest X-Ray

Guidelines recommend chest x-ray (CXR) in children with positive tuberculosis (TB) screening tests (tuberculin skin test or interferon-gamma release assay). But how often does the CXR actually reveal a diagnosis of active TB in asymptomatic children? Australian researchers reviewed CXRs taken within 6 months of positive TB screening in 268 children (age range, 0–18 years) between 2006 and 2011. Most screened children were immigrants from countries with high TB prevalence or contacts of active TB cases.

Of the 57 children with CXRs suggestive of TB and clinical details available on chart review, 31 had symptoms consistent with pulmonary TB. In the 26 asymptomatic patients, CXR changes suggested prior TB (fibrous scarring, calcified node/granu…