{
  "id": "medical/tuberculin-skin-test-timing",
  "signature": "AI instructs a nurse to read a tuberculin skin test (TST) at 24 hours instead of the required 48-72 hours, leading to false-negative result",
  "signature_zh": "AI指示护士在24小时而非要求的48-72小时读取结核菌素皮肤试验（TST）结果，导致假阴性结果",
  "regex": "tuberculin.*(?:skin|test|TST|PPD).*read.*(?:24|48|72).*hour",
  "domain": "medical",
  "category": "protocol_error",
  "subcategory": null,
  "root_cause": "The AI output stated 'Read TST after 24 hours' based on a misinterpretation of CDC guidelines, which mandate reading at 48-72 hours; early reading misses delayed-type hypersensitivity reactions, causing false negatives.",
  "root_cause_type": "generic",
  "root_cause_zh": "AI输出'24小时后读取TST'，基于对CDC指南的误解；指南要求48-72小时后读取；过早读取会遗漏迟发型超敏反应，导致假阴性。",
  "versions": [
    {
      "version": "CDC TB Guidelines 2023",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "Epic Stork v2024.1",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "QuantiFERON-TB Gold Plus v2.0",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "",
      "why_fails": "The test must be read within the 48-72 hour window; a 24-hour reading is invalid and cannot be 'corrected' by a later reading because the induration may have already peaked and subsided.",
      "fail_rate": 0.8,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Chest X-ray is not a substitute for TST; it detects active disease, not latent infection. A negative X-ray does not rule out latent TB.",
      "fail_rate": 0.75,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "IGRA is an alternative, but the invalid TST should be documented and the patient informed; IGRA may not be covered by insurance if TST was already performed.",
      "fail_rate": 0.6,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Document the invalid TST (read at 24h) as 'uninterpretable' in the EHR. Order a new TST and schedule a return visit at 48-72 hours. Provide patient with written instructions: 'Do not read the test yourself; return to clinic exactly 48-72 hours after placement.'",
      "success_rate": 0.95,
      "how": "Document the invalid TST (read at 24h) as 'uninterpretable' in the EHR. Order a new TST and schedule a return visit at 48-72 hours. Provide patient with written instructions: 'Do not read the test yourself; return to clinic exactly 48-72 hours after placement.'",
      "condition": "",
      "sources": []
    },
    {
      "action": "If the patient cannot return, switch to IGRA (QuantiFERON-TB Gold Plus) as a single-visit alternative. Order in EHR: 'IGRA for LTBI screening, reason: TST reading window missed.'",
      "success_rate": 0.9,
      "how": "If the patient cannot return, switch to IGRA (QuantiFERON-TB Gold Plus) as a single-visit alternative. Order in EHR: 'IGRA for LTBI screening, reason: TST reading window missed.'",
      "condition": "",
      "sources": []
    },
    {
      "action": "Implement a hard stop in the nursing documentation system: if TST reading time is <48 hours, block finalization and display: 'TST reading invalid: must be 48-72 hours after placement. Re-enter time or order repeat test.'",
      "success_rate": 0.85,
      "how": "Implement a hard stop in the nursing documentation system: if TST reading time is <48 hours, block finalization and display: 'TST reading invalid: must be 48-72 hours after placement. Re-enter time or order repeat test.'",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "Document the invalid TST (read at 24h) as 'uninterpretable' in the EHR. Order a new TST and schedule a return visit at 48-72 hours. Provide patient with written instructions: 'Do not read the test yourself; return to clinic exactly 48-72 hours after placement.'",
    "If the patient cannot return, switch to IGRA (QuantiFERON-TB Gold Plus) as a single-visit alternative. Order in EHR: 'IGRA for LTBI screening, reason: TST reading window missed.'",
    "Implement a hard stop in the nursing documentation system: if TST reading time is <48 hours, block finalization and display: 'TST reading invalid: must be 48-72 hours after placement. Re-enter time or order repeat test.'"
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.cdc.gov/tb/publications/guidelines/testing.htm",
  "official_doc_section": null,
  "error_code": "TST-TIMING-ERR-04",
  "verification_tier": "ai_generated",
  "confidence": 0.84,
  "fix_success_rate": 0.92,
  "resolvable": "true",
  "first_seen": "2024-08-05",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}