755. Clinical Adherence to Latent Tuberculosis Screening Recommendations in Adults with Inflammatory Bowel Disease (IBD) Prior to Biologic Therapy
Bibliographic record
Abstract
Abstract Background Biological agents have become increasingly common in the treatment of immune-mediated illnesses. Their use, however, is associated with an increased risk of progression from latent to active tuberculosis (TB) infection. The American Thoracic Society (ATS) recommends both a tuberculin skin test (TST) and an interferon gamma release assay (IGRA) be conducted to screen for latent TB prior to initiation of biologic therapy. We examined the adherence to these recommendations for adults with inflammatory bowel disease (IBD) in the Calgary region of Alberta. Methods In this retrospective cross-sectional study, we used the Alberta Health Services’ Sunrise Clinical Manager and Netcare databases to identify IBD patients initiated on biologic therapy (age >18 years) in Calgary, Alberta between 2008 and 2018. Socio-demographic and clinical characteristics of patients were described. Linear and logistic regression models were constructed to identify factors associated with screening. All analyses were conducted using Stata 15.0 (University of London, UK). Results There was a total of 247 identified cases (48.18% female). Of these 96 were Ulcerative Colitis and 151 Crohn’s Disease. The mean age was 39.5 (14.8 SD). There was a total of 210 (85%) who had documented screening with the TST and nine (3.4%) with the IGRA. In a multivariable analysis, factors associated with latent TB screening were age and outpatient setting at the time of screen. Six patients (2.43%) had positive screens and four of those six were treated for latent TB infection. Conclusion TST remains the predominant screening method for latent TB infection although the ATS recommends both IGRA and TST prior to biologic therapy. Screening varied with age and higher rates were noted in those evaluated as outpatients compared with inpatients. Further work is needed to evaluate the barriers to screening and to improve access to latent TB screening particularly in the inpatient setting. Disclosures All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".