摘要：Objectives. This study sought to determine adherence of physicians to tuberculosis (TB) screening guidelines among foreign-born persons living in the United States who were applying for permanent residency. Methods. Medical forms of applicants from 5 geographic areas were reviewed, along with information from a national physician database on attending physicians. Applicant and corresponding physician characteristics were compared among those who were and were not correctly screened. Results. Of 5739 applicants eligible for screening via tuberculin skin test, 75% were appropriately screened. Except in San Diego, where 11% of the applicants received no screening, most of the inappropriate screening resulted from the use of chest x-rays as the initial screening tool. Conclusions. Focused physician education and periodic monitoring of adherence to screening guidelines are warranted. Individuals born outside the United States accounted for 46% of the 16 377 US cases of tuberculosis (TB) reported in 2000. 1 To eliminate TB in the United States, the Institute of Medicine and others have identified screening for the disease as a priority among individuals applying for permanent US residence. 2– 4 Previous studies have shown a high yield of cases from overseas screening 5, 6 ; however, with the exception of a limited evaluation in Denver, Colo, 7 in which the health department served as the sole screening agency for mostly Mexican applicants, adherence to or yield from the US-based screening process has not been evaluated. In the United States, through the process of applying for permanent US residency, 578 000 persons were screened in 1995, and this number increased to 760 000 in 1997. 8 These applicants undergo TB screening, and adherence to and yield from the recommended screening should interest public health officials. Applicants 2 years or older are given a Mantoux tuberculin skin test (TST); if a reaction of 5 mm or more is observed, a chest x-ray is required. If the x-ray suggests TB, the applicant must be referred to the local health department for evaluation. The guidelines also recommend referring applicants with a TST induration of 10 mm or more and a chest x-ray not suggestive of TB to the health department for consideration of preventive therapy. 9 Immigration and Naturalization Service (INS) district directors appoint individual physicians (known as civil surgeons) to perform screening examinations; these physicians must be licensed, have at least 4 years of experience, and be provided with guidelines ( Technical Instructions for Medical Examination of Aliens in the United States 9 ) developed by the Division of Quarantine of the Centers for Disease Control and Prevention (CDC). After performing examinations, physicians complete INS medical forms and return them to the INS. The United States has approximately 3000 civil surgeons, but the number currently performing examinations of applicants is unknown.
