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Table 2 Clinical actions: eliciting of clinical symptoms and examination (%)

From: Missed opportunities in TB diagnosis: a TB Process-Based Performance Review tool to evaluate and improve clinical care

 

Hospital A (n = 56)

Hospital B (n = 26)

Hospital C (n = 20)

Hospital D (n = 13)

 

Omitted

Action performed

Omitted

Action performed

Omitted

Action performed

Omitted

Action performed

  

Absent

Present

 

Absent

Present

 

Absent

Present

 

Absent

Present

Symptoms elicited

            

   Chest complaint

38

7

55

39

0

62

15

5

80

0

39

62

   Weight loss

63

5

32

73

0

27

55

0

45

15

8

77

   Fever/night sweats

46

9

44

81

0

19

60

5

35

0

54

46

Examination

            

Chest auscultation

abnormal

32

20

48

50

19

31

0

15

85

0

46

54

Evidence of weight

loss

63

0

38

69

0

31

35

0

65

85

0

15

   Pleural effusion

39

52

9

96

0

4

80

5

15

39

31

31

   Lymphadenopathy

86

5

9

89

12

0

40

45

15

31

23

46

   Hepatosplenomegaly

59

27

14

84

15

0

25

35

40

0

31

69

Neck stiffness/

confusion

71

23

5

73

12

15

45

35

20

15

62

23

  1. The TB-PBPR tool was used to evaluate medical records to determine whether clinical actions were omitted or performed. Where an action was performed, we recorded whether symptoms and examination findings were absent or present. For example, in hospital A, clinicians omitted eliciting symptoms of chest complaint (cough/haemoptysis/pain) in 38% of patients. Chest symptoms were elicited in the remaining patients (Action performed); these symptoms were absent in 7% and present in 55% of patients.