We teach it must be palpated without visual first then visual. Why? The read is trying to find the “iceberg” above and below the area. I always tell my new nurses to feel for the “iceberg below the water”. I have experienced induration not only felt above the skin but below it.

 

Must be palpated by someone who is not related or intimately involved with the patient. The reader must be at a RN, MD, PA, etc..

 

 

 

1. I agree that the person, their mother, etc should not be the one reading.  While most are not going to fudge the reading, in occ med and hospitals especially, there are implications of a positive test that the worker may choose to want to avoid- no matter how good the reading
2. I have taught nurses without a relationship to the worker and EMTs to read PPD in person and in some instances will accept that reading provided the reader is a trusted partner and its clear cut.
3. I teach readers to draw a pen point along into the area of induration from 4 directions and then measure.  I wonder if the points that are marked have been shown to be reliable  I believe they are as reliable if not more reliable than just the finger feeling the raised area and certainly more reliable than visual.   And can they then be measured correctly with a virtual view.   I think they can but don’t know of any literature or studies.

Karl Auerbach MD

Albany NY

My opinions,  nothing more….

 

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