Pediatric tuberculosis consultations across 5 CDC regional tuberculosis training and medical consultation Centers

Abstract

Background: The U.S. Centers for Disease Control and Prevention (CDC) funds five Regional Tuberculosis Training and Medical Consultation Centers (RTMCCs) that provide training and consultation for tuberculosis (TB) control and management. RTMCC utilization for assistance with diagnosis and management of TB in children has not been described. We analyzed pediatric TB consultations performed across all RTMCCs in terms of question type, provider type, and setting.

Methods: The CDC medical consultation database was queried for consultations regarding patients ≤ 18 years provided between 1/1/13-4/22/15 by all RTMCCs (Curry International TB Center, Heartland National TB Center, Mayo Clinic Center for TB, New Jersey Medical School Global TB Institute, Southeastern National TB Center). Each query was categorized into multiple subject areas based on provider type, setting, consultation topic, and patient age.

Results: The 5 RTMCCs received 1164 pediatric consultation requests, representing approximately 20% of all consultations performed by the centers during the study period. Providers requesting consults were primarily physicians (46.3%) or nurses (45.0%). The majority of pediatric consult requests were from state and local public health departments (679, 58.3%) followed by hospital providers (199, 17.1%); fewer requests came from clinicians in private practice (84, 7.2%) or academic institutions (40, 3.4%). Consults addressed 14 different topics, most commonly management of children with TB disease (19.1%), latent TB infection (LTBI) (18.2%), diagnosis or laboratory testing (18.7%), and pharmacology (9.2%).

Discussion: Pediatric consultations accounted for approximately 20% of all consultations performed by RTMCCs during the study period. RTMCCs were utilized primarily by public health departments regarding management of TB disease, LTBI, and diagnosis or laboratory testing. The relative underutilization of the RTMCCs by clinicians in non-public health settings, who often manage children with TB exposure or infection, warrants further study. As US TB case rates decline and providers become less experienced with childhood TB, medical consultation support may become increasingly important.

Keywords: Consultation; Pediatric; Tuberculosis.

Fig. 1

Distribution of provider types requesting RTMCC consultation for patients ≤ 18 years of age between 1/1/13 and 4/22/15. % of total consultations at each RTMCC is shown. Provider type was unspecified in 101/ 1164 (8.6%) of consultations.

Fig. 2

Setting of providers requesting pediatric consultations from RTMCCs between 1/1/13 and 4/22/15. % of 1164 consultations is shown. Other includes regional health offices, community health centers, and corrections facilities.

Fig. 3

Topic areas of pediatric consultations provided by RTMCCs between 1/1/13 and 4/22/15. 1164 consultations were categorized into 1 or more topic areas, yielding a total of 2104 consultations. Data include 19 patients > 18 years of age. Other category includes legal issues, nontuberculous mycobacteria and Human immunodeficiency virus (HIV)/TB. Diagnosis/lab category includes tuberculin skin test (TST) and interferon-gamma release assay (IGRA). Drug resistance category includes multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB.

Fig. 4

Patient age among 1164 pediatric consultations provided by RTMCCs between 1/1/13 and 4/22/15.