A Medical Audit of Consecutive Deaths in a Tuberculosis Hospital

¹ Toronto Hospital

The findings presented confirm that problems of differential diagnosis were presented by the patients who died in the tuberculosis unit of our hospital during the period under consideration. This study of deaths could only reflect the pattern of diseases which were encountered among the much larger number of patients discharged alive.

Factors with an unfavorable influence upon the progress of patients under treatment for active pulmonary tuberculosis included: loss of bacillary sensitivity to one or more of the three chief antituberculosis drugs; advanced stages of the disease before treatment was commenced; an inadequate length of time under treatment; complications in elderly men such as arteriosclerotic heart disease, chronic alcoholism, pulmonary emphysema and malnutrition.

The difficulties in judging the immediate cause of death under certain circumstances when tuberculosis is present, and the limitations of tuberculosis mortality statistics, should be more widely recognized. Other yardsicks may be used to measure progress toward the distant goal of tuberculosis eradication.

A careful and honest analysis or "audit" of consecutive deaths in a hospital can be useful for the interest and guidance of the medical staff. The time may come when each death where tuberculosis is reported as the immediate cause or as an associated condition will receive close scrutiny to bring to light any information which might be of value in improving the program for the prevention of this disease.