Editing Heaf test

{{Short description|Skin test for tuberculosis in children}}
{{more citations needed|date=July 2012}}
{{Infobox diagnostic
| name            = Heaf test
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| pronounce       = 
| purpose         =test tuberculosis in children (discontinued)
| test of         =
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The '''Heaf test''', a [[medical diagnosis|diagnostic]] skin test, was long performed to determine whether or not children had been exposed to [[tuberculosis]] infection.  The test was named after [[F. R. G. Heaf]].  Also known as the '''Sterneedle test''',<ref name="Nolan1996">{{cite book|last=Nolan|first=Thomas E.|title=Primary care for the obstetrician and gynecologist|url=https://books.google.com/books?id=XTDzmKfWkSQC&pg=PA285|accessdate=17 October 2010|year=1996|publisher=[[John Wiley & Sons|Wiley-IEEE]]|isbn=978-0-471-12279-1|page=285}}</ref> it was administered by a Heaf gun (trademarked "Sterneedle"),<ref>{{cite web|url=http://ip.com/pdf/patent/US3969497.pdf|title=Test substance for tuberculosis|date=13 July 1976|publisher=[[United States Patent and Trademark Office]]|accessdate=17 October 2010|quote=...multiple scratch scarifications by an instrument known as the Heaf gun (also known by the Trademark "Sterneedle"), or by...}}{{dead link|date=October 2017 |bot=InternetArchiveBot |fix-attempted=yes }}</ref>  a spring-loaded instrument with six needles arranged in a circular formation which was inserted in the wrist<ref>{{Cite web|url=http://www.credoreference.com/entry/blackmed/heaf_test|title=Heaf Test |year=2010|work=Black's Medical Dictionary, 42nd Edition|publisher=[[A & C Black]]|location=London|accessdate=17 October 2010}} {{subscription required}}</ref> or shoulder.

The Heaf test was discontinued in 2005 because the manufacturer deemed its production to be financially unsustainable after manufacturers could not be found for [[tuberculin]] or Heaf guns.  Until 2005, the test was used in the United Kingdom to determine if the [[Bacillus Calmette-Guérin|BCG]] vaccine was needed; the [[Mantoux test]] is now used instead.  The Heaf test was preferred in the UK, because it was thought to be easier to interpret, with less variability between observers, and less training was required to administer and read the test.

Patients who exhibited a negative reaction to the [[Test method|test]] were considered for [[Bacillus Calmette-Guérin|BCG]] vaccination.

The Heaf test was used to test for tuberculosis in [[Adolescence|adolescents]] aged around 13–14.<ref>{{Cite encyclopedia|first1=Ian|last1=Shaw|first2=Louise|last2=Woodward|url=http://www.credoreference.com/entry/sprmedanth/british|title=Cultures: British |year=2004|encyclopedia=Encyclopedia of Medical Anthropology: Health and Illness in the World's Cultures|publisher=[[Springer Science+Business Media]]|location=Dordrecht|accessdate=17 October 2010}} {{subscription required}}</ref>
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==Procedure==
A '''Heaf gun''' was used to inject multiple samples of testing serum under the skin at once. The needle points were dipped in tuberculin purified protein derivative (PPD) and pricked into the skin.<ref>{{Cite web|url=http://www.credoreference.com/entry.do?id=3163273|title=Sterneedle test|year=1992|work=Academic Press Dictionary of Science and Technology|publisher=[[Elsevier#Science &Technology|Elsevier Science & Technology]]|location=Oxford|accessdate=17 October 2010}} {{subscription required}}</ref>
A Heaf gun with disposable single-use heads was recommended.

The gun injected PPD equivalent to 100,000 units per ml to the skin over the flexor surface of the left forearm in a circular pattern of six. The test was read between two and seven days later. The injection could not be into sites containing superficial veins.

The reading of the Heaf test was defined by a scale:<ref>{{Cite journal|last1=Galbraith|first1=N. S.|last2=Hanson|first2=Audrey|last3=Shoulman|first3=R.|last4=Andrews|first4=D. W.|last5=Lee|first5=D. B.|date=1972|title=Interpretation Of Positive Reactions To Heaf Tuberculin Test In London Schoolchildren|journal=The British Medical Journal|volume=1|issue=5801|pages=647–649|doi=10.1136/bmj.1.5801.647|jstor=25417979|pmid=4622617|pmc=1787811|issn=0007-1447}}</ref>
* Negative – no induration, maybe six minute puncture scars
* Grade 1 – four to six [[papules]] (also considered negative)
* Grade 2 – confluent papules form indurated ring (positive)
* Grade 3 – central filling to form disc (positive)
* Grade 4 – disc >10&nbsp;mm with or without blistering (strongly positive)

Grades 1 and 2 could result from previous BCG or avian tuberculosis, rather than human TB infection.

Children who were found to have a grade 3 or 4 reaction were referred for [[X-ray]] and follow-up.

For interpretation of the test, see [[Tuberculosis diagnosis]].

==Other tests==
The equivalent [[Mantoux test]] positive levels done with 10 TU (0.1 mL 100 TU/mL, 1:1000) are
* 0–4&nbsp;mm induration (Heaf 0-1)
* 5–14&nbsp;mm induration (Heaf 2)
* &gt;15&nbsp;mm induration (Heaf 3-4)

The [[Mantoux test]] is preferred in the [[United States]] for the diagnosis of tuberculosis; multiple puncture tests, such as the Heaf test and [[Tine test]], are not recommended.

==References==
{{refbegin}}
* Joint Tuberculosis Committee of the British Thoracic Society, ''[http://thorax.bmjjournals.com/cgi/content/full/55/11/887 Control and prevention of tuberculosis in the United Kingdom: Code of Practice 2000]'' [[BMJ]] 2000:55:887-901. [https://web.archive.org/web/20041224162852/http://thorax.bmjjournals.com/cgi/content-nw/full/55/11/887/T3 Table 3 Heaf Test] grading, reaction, and equivalent Mantoux positive levels.  {{doi|10.1136/thorax.55.11.887}} {{PMID|11050256}}
{{refend}}
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{{Tuberculosis}}

[[Category:Immunologic tests]]
[[Category:Tuberculosis]]