Autopsy interrogation of emergency medicine dispute cases: how often are clinical diagnoses incorrect?

Liu, Danyang; Gan, Rongchang; Zhang, Weidi; Wang, Wei; Saiyin, Hexige; Zeng, Wenjiao; Liu, Guoyuan

doi:10.1136/jclinpath-2017-204484

Cited by 17 publications

(25 citation statements)

References 18 publications

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“…In addition, it’s important to identify the time of thrombus formation because it correlates with the time of death; thus, it is possible to evaluate with high probability if the clinical treatment has been corrected [12]. Several studies have evaluated the discrepancies between clinical and autopsy diagnoses, demonstrating that the use of different imaging techniques seldom contribute directly to inaccurate or missed diagnoses [18–20]. Despite progress in imaging techniques and therapeutic treatment, the importance of autopsy remains crucial to elucidate the cause of death.…”

Section: Discussionmentioning

confidence: 99%

The dating of thrombus organization in cases of pulmonary embolism: an autopsy study

Mansueto

Costa

Capasso

et al. 2019

BMC Cardiovasc Disord

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BackgroundPulmonary embolism (PE) is associated to high mortality rate worldwide. However, the diagnosis of PE often results inaccurate. Many cases of PE are incorrectly diagnosed or missed and they are often associated to sudden unexpected death (SUD). In forensic practice, it is important to establish the time of thrombus formation in order to determine the precise moment of death. The autopsy remains the gold standard method for the identification of death cause allowing the determination of discrepancies between clinical and autopsy diagnoses. The aim of our study was to verify the morphological and histological criteria of fatal cases of PE and evaluate the dating of thrombus formation considering 5 ranges of time.MethodsPulmonary vessels sections were collected from January 2010 to December 2017. Sections of thrombus sampling were stained with hematoxylin and eosin. The content of infiltrated cells, fibroblasts and collagen fibers were scored using a semi-quantitative three-point scale of range values.ResultsThe 30 autopsies included 19 males (63.3%) and 11 females (36.7%) with an average age of 64.5 ± 12.3 years. The time intervals were as follows: early (≤1 h), recent (> 1 h to 24 h), recent-medium (> 24 h to 48 h), medium (> 48 h to 72 h) and old (> 72 h). In the first hour, we histologically observed the presence of platelet aggregation by immunofluorescence method for factor VIII and fibrinogen. The presence of lymphocytes has been identified from recent thrombus (> 1 h to 24 h) and the fibroblast cells were peripherally located in vascular tissue between 48 and 72 h, whereas they resulted central and copious after 72 h.ConclusionsAfter a macroscopic observation and a good sampling traditional histology, it is important to identify the time of thrombus formation. We identified histologically a range of time in the physiopathology of the thrombus (early, recent, recent-medium, medium, old), allowing to determine the dating of thrombus formation and the exact time of death.Clinical trial numberNCT03887819.Trial registrationThe trial registry is Cliniclatrials.gov, with the unique identifying number NCT03887819. The date of registration was 03/23/2019 and it was “Retrospectively registered”.

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Section: Discussionmentioning

confidence: 99%

The dating of thrombus organization in cases of pulmonary embolism: an autopsy study

Mansueto

Costa

Capasso

et al. 2019

BMC Cardiovasc Disord

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“…Previous studies comparing clinical diagnoses and autopsy findings revealed major discrepancies in approximately 10–40% of the deceased patients undergoing post-mortem examination [3–5]. Thus, complete diagnostic autopsy is an important tool for quality control of clinical practice [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…The reasons for this decline have been discussed previously in literature [3,4,6] and include, among others, introduction of modern diagnostic tools in clinical practice. However, it is widely accepted that clinico-pathological discrepancies still occur even in the era of high-tech medicine [7,8,10], being much more frequent in low and middle income countries (LMIC), in which the availability of diagnostic techniques is limited [9]. Therefore, autopsies still have a crucial role in quality control of the clinical diagnosis and overall patient management.…”

Section: Introductionmentioning

confidence: 99%

Clinico-pathological discrepancies in the diagnosis of causes of death in adults in Mozambique: A retrospective observational study

et al. 2019

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Background Clinico-pathological discrepancies are more frequent in settings in which limited diagnostic techniques are available, but there is little information on their actual impact. Aim We assessed the accuracy of the clinical diagnoses in a tertiary referral hospital in sub-Saharan Africa by comparison with post-mortem findings. We also identified potential risk factors for misdiagnoses. Methods One hundred and twelve complete autopsy procedures were performed at the Maputo Central Hospital (Mozambique), from November 2013 to March 2015. We reviewed the clinical records. Major clinico-pathological discrepancies were assessed using a modified version of the Goldman and Battle classification. Results Major diagnostic discrepancies were detected in 65/112 cases (58%) and were particularly frequent in infection-related deaths (56/80 [70%] major discrepancies). The sensitivity of the clinical diagnosis for toxoplasmosis was 0% (95% CI: 0–37), 18% (95% CI: 2–52) for invasive fungal infections, 25% (95% CI: 5–57) for bacterial sepsis, 34% (95% CI: 16–57), for tuberculosis, and 46% (95% CI: 19–75) for bacterial pneumonia. Major discrepancies were more frequent in HIV-positive than in HIV-negative patients (48/73 [66%] vs. 17/39 [44%]; p = 0.0236). Conclusions Major clinico-pathological discrepancies are still frequent in resource constrained settings. Increasing the level of suspicion for infectious diseases and expanding the availability of diagnostic tests could significantly improve the recognition of common life-threatening infections, and thereby reduce the mortality associated with these diseases. The high frequency of clinico-pathological discrepancies questions the validity of mortality reports based on clinical data or verbal autopsy.

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“…Autopsije imaju značajnu ulogu u proceni kvaliteta zdravstvene službe, posebno službe hitne medicinske pomoći i jedinica intenzivne nege (JIN), kako internističke tako i hirurške [1]. Takođe, one omogućavaju lekarima uvid u adekvatnost primenjenih dijagnostičkih i terapijskih procedura i na taj način proširuju aktuelna znanja o različitim bolestima [1,2].…”

Section: Uvodunclassified

Cause of death during the first 24 hours after hospitalization: An autopsy study

Janković¹,

Jordanova²,

Jevtić³

et al. 2020

Halo 194

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Introduction/Objective Postmortem examination has a significant role in evaluating the quality of health care. The objective of the paper is to analyze the cause of death as determined by postmortem examination in patients who had undergone emergency hospitalization and had subsequently died within 24h, as well as the factors that contributed to the fatal outcome and correlation with available clinical data. Methods the analysis included autopsy reports and protocols, as well as clinical data from medical records and autopsy referrals during the three year period (2018-2020) for patients who had undergone a postmortem examination at the Insitute of Pathology, Medical Faculty, University of Belgrade. The correlation between the clinical diagnosis and postmortem findings was evaluated using Goldman criteria. Results the patients analysed were predominantly male (52/90; 58%). Women were statistically significantly older than men (p=0.024). The most common clinical diagnosis was cardiovascular disease (32.2%). The majority of the patients reported experiencing the first symptoms a few hours before seeking medical help (80%). The majority of the patients were being treated for chronic disease (80%) before hospitalization. The immediate cause of death determined by postmortem examination was most commonly heart failure (38/90, 42.2%). The most common clinically unrecognised causes of death include: bronchopneumonia (8/90), myocarditis (3/90), acute ischemic lesion/acute myocardial infarction (3/90) and bowel infarction (3/90). Conclusion the correlation between clinical and postmortem findings is very important because it enables the discovery of diagnostic and treatment errors and promotes new knowledge crucial for medical advancement.

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Autopsy interrogation of emergency medicine dispute cases: how often are clinical diagnoses incorrect?

Cited by 17 publications

References 18 publications

The dating of thrombus organization in cases of pulmonary embolism: an autopsy study

The dating of thrombus organization in cases of pulmonary embolism: an autopsy study

Clinico-pathological discrepancies in the diagnosis of causes of death in adults in Mozambique: A retrospective observational study

Cause of death during the first 24 hours after hospitalization: An autopsy study

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