Latent tuberculosis infection diagnosis and management in pediatric primary care: The role of electronic health record-based screening

ABSTRACT Background and Objectives Annual tuberculosis (TB) screening is recommended for all children and adolescents in the United States, but gaps remain in the diagnosis and treatment of latent TB infection (LTBI). We utilized the electronic health record (EHR) to examine the pediatric LTBI care cascade and assessed if an EHR note template could increase risk factor screening. Methods We extracted EHR data from well-child and -adolescent visits at a federally qualified health center in Northern California from 2014-2020. We constructed the LTBI care cascade from screening through treatment and performed multivariable logistic regression to assess factors associated with completion of cascade steps. A TB risk factor question was added to the progress note template in 2014, and we measured the change in TB risk factor screening and testing over time. Results We included 10,409 children from 18,681 visits, with median age of 6.9 years (IQR 2.8-12.1). Most visits (90%) had completed risk factor screening, and the note template significantly increased screening over time. However, 20% with a TB risk factor had testing ordered, though the proportion increased from 7% to 33% throughout the period. Of those tested, 4% had a positive test, and the majority completed subsequent steps. Children under 5 years old were more likely to have risk factor screening than older children but were less likely to be tested. Conclusions LTBI risk factor screening is high, but ongoing gaps in testing could have led to underdiagnosis. Simple EHR-based solutions have the potential to improve pediatric TB care. Article Summary We examined the care cascade for latent tuberculosis infection (LTBI) in children and evaluated the role of the electronic health record to support LTBI care. What’s Known on This Subject The American Academy of Pediatrics recommends annual tuberculosis screening at well-child visits, but gaps remain in completion of the care cascade. Electronic health record (EHR) systems can be utilized to monitor and guide completion of health maintenance activities. What This Study Adds Prior efforts to characterize the latent tuberculosis infection (LTBI) care cascade for children were incomplete, with limited EHR-based interventions. This study provides a full assessment of the LTBI care cascade and examines the role of the EHR to improve screening.