Accuracy of clinical diagnoses in a teaching hospital: a review of 997 autopsies

Kajiwara, João Kazuyuki; Zucoloto, Sérgio; Manço, Amábile Rodrigues Xavier; Muccillo, Gerson; Barbieri, Ma

doi:10.1111/j.1365-2796.1993.tb00728.x

Cited by 24 publications

(27 citation statements)

References 18 publications

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“…In 50% of cases, the diagnoses were made at autopsy, and many times they included important diseases such as bronchopneumonias (46%), neoplasias (37.9%), venous thromboses (82.5%) and pulmonary embolisms (80.3%). These data agree with the literature, which shows that 45% of the bronchopneumonias are diagnosed at autopsy (6), as well as 26 to 44% of the neoplasias (6,21,23,24) and 87% of the pulmonary embolisms (15,25).…”

Section: Discussionsupporting

confidence: 82%

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Discrepancies between clinical diagnoses and autopsy findings

Coradazzi

Morganti

Montenegro

2003

Braz J Med Biol Res

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Autopsy examination is considered to be an essential element for medical auditing and teaching. Despite the significant progress in diagnostic procedures, autopsy has not always confirmed the clinical diagnosis. In the present study, we compared the diagnosis recorded on medical charts with reports of 96 autopsies performed at the University Teaching Hospital of the Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil, between 1975 and 1982, and of 156 autopsies performed at the same institution between 1992 and 1996. The clinical diagnosis of the basic cause of death was confirmed at autopsy in 77% of cases. The percent confirmation fell to 60% when the immediate terminal cause of death was considered, and in 25% of cases, the terminal cause was only diagnosed at autopsy. The discrepancies between clinical and autopsy diagnosis were even larger for secondary diagnoses: 50% of them were not suspected upon clinical diagnosis. Among them, we emphasize the diagnosis of venous thromboses (83%), pulmonary embolisms (80%), bronchopneumonias (46%) and neoplasias (38%). Iatrogenic injuries were very frequent, and approximately 90% of them were not described in clinical reports. Our results suggest that highly sensitive and specific diagnostic tests are necessary but cannot substitute the clinical practice for the elaboration of correct diagnoses.

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Section: Discussionsupporting

confidence: 82%

“…Class I discrepancies are found in 7 to 13% of cases, and class II in 15 to 25% (7,9,(11)(12)(13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

Discrepancies between clinical diagnoses and autopsy findings

Coradazzi

Morganti

Montenegro

2003

Braz J Med Biol Res

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“…Cardiovascular diseases were found to be the main cause of death (42.8%) of autopsy diagnoses, confirming the impact of cardiovascular findings described by other authors 6,10,13 . The 8% autopsy rate in our series is similar to hospital autopsy rates in the United States (12%) and some studies in United Kingdom (11 to 24%) 14 .…”

Section: Discussionsupporting

confidence: 76%

“…Discrepancies between clinical and pathology diagnoses may occur due to the high frequency of the disease, diagnostic difficulties, or even because of the sudden nature of some diseases (myocardial infarction, aorta dissection, pulmonary embolism, stroke), which do not allow adequate time for clinical investigations 10 .…”

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confidence: 99%

Discrepâncias clínico-patológicas e achados cardiovasculares em 409 autópsias consecutivas

Fares

Fares²,

Fares³

et al. 2011

Arq. Bras. Cardiol.

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“…In the United States, autopsy rates of death due to overall causes and stroke have been progressively declining since 1972, and less than 5% of deaths attributed to stroke have been documented by autopsy since 1982 [8] . However, studies addressing the accuracy of clinical diagnoses using autopsy as the gold standard have revealed that postmortem examination is still a useful tool for diagnosis mainly among the elderly [9,10] . An intensivecare-based study revealed that 66.7% of the clinical diagnoses of the basic cause were correct, and that in 23.3% of cases, an error in the diagnosis of the basic cause occurred which, if detected before death, would probably have changed the patient's treatment and clinical course [11] .…”

Section: Discussionmentioning

confidence: 99%

Higher Burden of Hemorrhagic Stroke among Women

Aikawa

Bambirra²,

Seoane³

et al. 2005

Neuroepidemiology

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The aim of this study was to verify the gender difference in sudden cardiovascular death, mainly comparing brain infarction and hemorrhagic stroke. We analyzed 970 autopsy cases from a total of 3,802 nonviolent deaths (448 considered as sudden deaths, 296 undetermined, and 226 non-sudden deaths) including patients aged 30–69 years. All cardiovascular diseases were responsible for 69% of sudden deaths, and all types of stroke for only 14%. The proportions of sudden death for all cardiovascular diseases, coronary heart disease and ischemic stroke deaths were similar for both sexes. However, sudden deaths due to all types of stroke (women 20.0%; men 11.1%; p = 0.012) and hemorrhagic stroke (women 15.6%; men 7.9%; p = 0.019) were significantly more frequent among women when compared to men, the main cause being subarachnoid hemorrhage (women 5.6%; men 1.0%; p = 0.011). Hemorrhagic stroke deaths were usually sudden deaths among women.

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Accuracy of clinical diagnoses in a teaching hospital: a review of 997 autopsies

Abstract: If autopsies are heeded without bias, they will continue to give important feedback concerning medical diagnosis.

Cited by 24 publications

References 18 publications

Discrepancies between clinical diagnoses and autopsy findings

Discrepancies between clinical diagnoses and autopsy findings

Discrepâncias clínico-patológicas e achados cardiovasculares em 409 autópsias consecutivas

Higher Burden of Hemorrhagic Stroke among Women

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