Recent research in the mining industry (SIMHEALTH 611) reviewed the autopsy findings and medical records of miners who died during 1999. It was found that clinicians failed to diagnose PTB in 44%, incorrectly ascribed PTB as the cause of death in 29%, and correctly ascribed PTB as the cause of death in 27% of cases who either had TB on autopsy or were diagnosed as having TB during life.

The high rate of missed diagnoses means that many patients will have died prematurely. It also means that patients continue to spread the TB organism to their fellows, when early diagnosis and treatment would have prevented this. This project aims to produce and distribute material that will help to improve clinical performance and programme management of TB.

PROCESS-BASED PERFORMANCE REVIEW, undertaken by health professionals themselves, is one of the most effective ways of developing successful practice habits. A crucial step in initiating performance review is feedback to clinicians, which the autopsy examination of the lungs provides. Structured flow sheets, which enable a review of medical records together with knowledge of the autopsy findings, provide an efficient mechanism for constructive evaluation of clinical actions. A single page Process-Based Performance Review Flow Sheet has been designed, and is provided together with summaries of critical topics detailing why, when and how to perform essential investigations. Links have been provided in the flow chart to lead the reviewer to the relevant summaries of critical topics as well as more detailed guidance and information about any missed opportunities for diagnosis. Completion of the flow sheet has been accredited for CPD points.


This material will help health professionals to:


  1. Murray J, et al. Clinico-pathological study to reduce the rate of missed and misdiagnosis of pulmonary tuberculosis in the South African Mining Industry. SIMHEALTH 611, 2000.

  2. Sackett DL, et al. Evidence-based Medicine, 2nd Edition. Edinburgh: Churchill Livingstone, 2000.

  3. Sackett DL, et al. Clinical epidemiology. A basic science for clinical medicine. 2nd Edition. Little, Brown and Company: Boston/Toronto/London, 1991.

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Last edited 25/Jan/2002