A Comparison of the Antemortem Clinical Diagnosis and Autopsy Findings for Patients Who Die in the Emergency Department

Abstract

Objectives: In spite of advances in medical technology, there remains a high discrepancy rate between the antemortem clinical diagnosis and postmortem examination diagnosis for patients who die in hospitals. The aim of this study was to compare the clinical and postmortem examination diagnoses of patients who died in the emergency department (ED) of a tertiary hospital, and to analyze any discrepancy between them. Methods: The study was a retrospective chart review of patients who died in the ED of a tertiary referral teaching hospital and a comparison of the antemortem diagnosis with the autopsy diagnosis. Any missed diagnosis was classified, according to the Goldman criteria, into major and minor missed diagnoses. Results: A total of 59 patients were eligible for inclusion in the study. There was complete agreement between the antemortem diagnosis and the autopsy result in 51% of cases. The incidence of major missed diagnoses-where if the diagnosis had been known before the patient died, treatment may have been altered or survival may have been prolonged-was 7%. Conclusions: There is a significant discrepancy rate between the antemortem diagnosis and the autopsy diagnosis. However, in this study, serious missed diagnoses in which outcome may have been significantly altered are unusual among those who die in the ED of a tertiary referral hospital. Key words: autopsy; postmortem examination; emergency medicine; diagnosis. ACADEMIC EMERGENCY MEDICINE 2002; 9:957-959. Postmortem examinations, although suffering a decline in usage during the past few decades, remain a valuable contributor to our medical education and toward the understanding of medicine's limitations.1,2 Moreover, they serve as important quality assurance indicators of clinical acumen and diagnostic tools, and as a measure of the efficacy and appropriateness of any therapy administered. 3,4 In spite of advances in medical technology, there is still a high discrepancy rate between the clinical and postmortem diagnoses of deceased patients. 5,6

Emergency department deaths despite active management: Experience from a tertiary care centre in a low‐income country

“…Two studies from the USA, for example, show that cardiac, cerebrovascular, trauma and pulmonary embolism are the major causes of ED deaths unlike sepsis and pneumonia found in the present study. 1,9 A significant number of patients had been in contact with another health-care facility for their present illness. This highlights deficiencies in the health-care system of a low-income country like Pakistan.…”

Comparison of antemortem clinical diagnosis and post-mortem findings in intensive care unit patients

“…Autopsy is considered an important tool to evaluate the presence and extent of disease, to advance medical knowledge, to improve clinical practice, to train young physicians, especially for pathology trainees, but not only to teach students the fundamentals of anatomy and pathology. Moreover, it is an important quality assurance indicator of patient management, in terms of diagnosis and treatment [1,2]. There is a considerable amount of studies comparing the accuracy of clinical diagnosis over the years and despite all the progress and new diagnostic resources available, errors in diagnosis still occur [3][4][5][6].…”

“…The persistence of discordances between clinical and post-mortem diagnosis (PME) advocates the continuous autopsy practice [7][8][9]. Moreover, studies carried out in the last three decades in different groups of patients (neonatal, pediatric, psychiatric, geriatric patients) in university hospitals or not, failed to show a meaningful increase between antemortem and post-mortem diagnosis [1,7,[9][10][11][12][13][14][15][16][17].…”

Discrepancies between clinical diagnoses and autopsy findings: A comparative study conducted in South Africa

“…Notably, they serve as a quality management tool to evaluate accuracy in clinical diagnoses, diagnostic imaging and other special investigations. [1,4,5] Although the autopsy and autopsy histology are being undermined, these modalities are ultimately the most accurate means of detecting clinicopathological discrepancies and are therefore considered the gold standard in determining the cause of death, as well as in the audit of clinical diagnoses, diagnostic tests and death certification. [6,7] Other fields of quality assurance are evaluation of efficacy and potential adverse effects of new drugs, new surgical techniques and genetic engineering.…”