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Free Content The tuberculin skin test: a comparison of ruler and calliper readings

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BACKGROUND: The Mantoux tuberculin skin test (TST) is widely used to diagnose latent infection with Mycobacterium tuberculosis. TST skin induration may be measured either by a transparent ruler or by a pair of callipers. We hypothesised that the type of instrument used may affect the reading.

OBJECTIVE: To determine whether variability in Mantoux TST measurement is affected by the type of reading instrument.

METHOD: A TST (Mantoux method) was performed among healthy adolescents. The indurations were read with among ruler and calliper by two independent readers. Limits of agreement and Kappa (κ) scores at TST positivity cut-off points were calculated. A Bland-Altman graph was constructed.

RESULTS: The 95% limits of agreement between instruments ranged from −5 mm to 3 mm. The limits of agreement between readers ranged from −5 mm to 4 mm. κ scores between instruments were respectively 0.7 and 0.8 at 15 mm and 10 mm cut-offs.

CONCLUSION: The variability between readers of TST indurations is not influenced by changing the reading instrument.
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Keywords: Mantoux; tuberculin skin test; tuberculosis diagnosis

Document Type: Regular Paper

Affiliations: 1: South African Tuberculosis Vaccine Initiative, University of Cape Town, Cape Town, South Africa; and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa 2: KNCV Tuberculosis Foundation, Amsterdam, The Netherlands; and Centre for Infection and Immunity, Academic Medical Centre Amsterdam, University of Amsterdam, Amsterdam, The Netherlands

Publication date: 01 October 2010

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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