To the Editor.—We agree with the conclusion of Counsell et al1 that a low index of suspicion leading to late diagnosis of tuberculosis contributes to the continued occurrence of this disease. As these authors recognized, this delay in diagnosis represents a special risk to health care workers. The recommendation of the American Thoracic Society, New York, NY, and the Centers for Disease Control, Atlanta, Ga, to develop an admission surveillance plan for acute care hospitals by emphasizing the indications for tuberculin skin testing may not adequately correct diagnostic delay if errors of omission in documenting test results occur.
During a review of medical charts for 1987 at Vanderbilt University Hospital, Nashville, Tenn, a 520-bed tertiary care center, it was found that of six patients with newly diagnosed tuberculosis, two of these were staff nurses, one of whom recalled exposure to a patient whose diagnosis of tuberculosis was delayed. In