Clinical and pathological disagreement upon the cause of death in a teaching hospital: Analysis of 100 autopsy cases in a prospective study

Abstract

The aim of the present study was to analyze the concordance between clinical and autopsy diagnoses. For this purpose, 100 patients submitted to autopsy from July 2000 to April 2001 were studied prospectively. In all cases, clinicians gave the immediate and the underlying causes of death for patients dying under their care. The diagnoses were compared to the macroscopic autopsy diagnoses. Cohen's kappa coefficient of agreement was estimated. Sixty-four men and 36 women were submitted to autopsy. The most frequent pathological diagnosis of underlying cause of death were diseases of the circulatory system (35%), infections and parasitic diseases (20%) and diseases of the digestive system (11%). The kappa coefficient for immediate cause of death was 0.40 (95% confidence interval (CI): 0.29-0.50); for underlying cause it was 0.38 (95%CI: 0.18-0.44), and for basic cause codified by group according to ICD-10 it was 0.55 (95%CI: 0.44-0.67). Major disagreement occurred in 10 cases involving pathological causes of death as circulatory diseases, in which the clinicians diagnosed a digestive system disease as the cause of death (n = 5), or infectious and parasitic diseases (n = 5). The present study shows that agreement between clinical and pathological causes of death are moderate, proving that the autopsy is still a very important procedure.

Postmortem CT is more accurate than clinical diagnosis for identifying the immediate cause of death in hospitalized patients: a prospective autopsy-based study

“…The accuracy of the clinical diagnosis regarding the underlying cause of death is estimated at 75 to 90 %, based upon several hospital autopsy validation studies [ 2 , 4 , 6 , 21 ]. However, some studies have noted that the accuracy of clinical diagnosis of the immediate cause of death is lower than that of the primary cause of death, based upon hospital autopsy data [ 22 – 24 ]. Recent literature indicates that the correspondence rate of the immediate cause of death as determined by postmortem CT and hospital autopsy reaches approximately 70 % [ 25 , 26 ], indicating that the accuracy of the determination of the immediate cause of death by postmortem CT is superior to that by clinical diagnosis.…”

Postmortem Study of Histopathological Lesions of Heart in Cases of Sudden Death - An Incidental Findings

“…Over one-fifth of clinically unexpected autopsy findings can be correctly diagnosed only by histological examination. [13][14] The aim of present study was to identify the various histopathological lesions of the heart found incidentally and play a major role as a cause of death in cases of sudden death.…”

Discrepâncias clínico-patológicas e achados cardiovasculares em 409 autópsias consecutivas

“…Nowadays, the advances in medical technologies, as well as economic and legal reasons are cited as justifications for this decline 3 . However, autopsy is still one of the most reliable methods to validate clinical diagnoses 4 .…”