Discrepancies Between Clinical and Autopsy Diagnoses

Tavora, Fabio; Crowder, Clinton D.; Sun, Chen-Chi; Burke, Allen

doi:10.1309/9m7dfe62rtdkhh4d

Cited by 69 publications

(24 citation statements)

References 21 publications

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“…This is consistent with a report by Friedlander in England who reported more than a quarter of autopsies resulting to major surprises other than the said antemortem cause of death [6]. …”

Section: Discussionsupporting

confidence: 92%

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The Role of Necropsy in Diagnostic Dilemmas as Seen in a Tertiary Hospital in North Central Nigeria

Silas

Adoga

Manasseh

et al. 2009

Journal of Tropical Medicine

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Background. Necropsy (autopsy) has helped medical science and law. It has given rise to numerous diagnostic surprises as it explains cause of death, pathogenesis of diseases, and circumstances of death. It also explains reasons for most therapeutic failures. In spite of its usefulness, the rate has dropped worldwide and Africa is worse hit. This work aims to highlight the role autopsy (Necropsy) plays in demystifying diagnostic dilemmas and to encourage its patronage by medical practitioners, law enforcement agents and society. Methods. This is a retrospective review of autopsy and clinical reports of cases seen by pathologists and physicians in the Jos University Teaching Hospital (JUTH), Jos, North central Nigeria. Results. A total 166 cases were studied out of which 52 had same diagnosis for both attending physician and pathologist, 106 had different diagnoses and in eight cases diagnoses remained unknown even after autopsy was performed. Conclusions. Autopsy remains an important tool for obtaining definitive diagnosis, determining cause of death to explain pathogenesis of diseases, medical auditing and a vital source of data for health statistics and planning.

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“…This is consistent with a report by Friedlander in England who reported more than a quarter of autopsies resulting to major surprises other than the said antemortem cause of death [6]. …”

Section: Discussionsupporting

confidence: 92%

“…This calls for the need to request for autopsies for medical auditing to sharpen clinical acumen. Friedlander reported that autopsy results have been able to aid by obtaining confirmative diagnosis of patients [6]. …”

Section: Discussionmentioning

confidence: 99%

The Role of Necropsy in Diagnostic Dilemmas as Seen in a Tertiary Hospital in North Central Nigeria

Silas

Adoga

Manasseh

et al. 2009

Journal of Tropical Medicine

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“…Antemortem medical and forensic information should be evaluated jointly [29, 30]. The range of events presented in our study is sufficient to demonstrate the variety of cases.…”

Section: Discussionmentioning

confidence: 98%

Diffuse Alveolar Damage of the Lungs in Forensic Autopsies: Assessment of Histopathological Stages and Causes of Death

Ürer

Ersoy

Yilmazbayhan

2012

The Scientific World Journal

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Introduction. Diffuse alveolar damage (DAD) is a morphological prototype of acute interstitial pneumonia. Hospital autopsies or open-lung biopsies are used to monitor common alveolar damage and hyaline membrane (HM) development histopathologically. The aim of this study was to detect histopathological profiles and frequency of DAD and HM in adult forensic autopsies. Materials and Methods. In total, 6813 reports with histopathological samples in 12,504 cases on which an autopsy was performed between 2006 and 2008 were investigated. Sixty-six individuals >18 years of age who were diagnosed with DAD were included. Hematoxylin- and eosin-stained lung preparations were reexamined in line with the 2002 American Thoracic Society/European Respiratory Society idiopathic interstitial pneumonia consensus criteria. Results. Histopathological examination revealed that 50 cases (75.7%) were in the exudative phase and 16 (24.2%) were in the proliferative phase. Only the rate of alveolar exudate/oedema in exudative phase cases (P = 0.003); those of alveolar histiocytic desquamation (P = 0.037), alveolar fibrosis (P = 0.017), chronic inflammation (P = 0.02), and alveolar fibrin (P = 0.001) in proliferative cases were significantly higher. The presence of alveolar fibrin was the only independent variable in favour of proliferative cases (P = 0.016). Conclusion. The detection of all DAD morphological criteria with the same intensity is not always possible in each case. Forensic autopsies may provide a favourable means for expanding our knowledge about acute lung damage, DAD, and interstitial lung disease.

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“…Depending on the severity of the trauma, and thus on the time available for establishing the diagnosis, the use of diagnostic means may be very limited. Yet, a recent study points out that the in-hospital survival time is inversely proportional to the discrepancy rate at autopsy, suggesting that lack of time for appropriate diagnostic tests have an important role in missed diagnoses [18]. Especially in fatal polytrauma cases the clinically assumed causes of death might vary from the autopsy point of view, depending on several factors such as the patient's pre-existing condition and age, mechanism of accident, necessity of CPR, survival time, and the possibility to perform emergency diagnostics: if severe injury patterns with elevated ISS levels necessitate continued CPR on the patient in immediate clinical course, intended advanced diagnostic measures (besides standardly conducted performance of physical body exploration, thoracic and pelvic x-ray scans as well as abdominal ultrasound examination) usually will initially be blocked.…”

Section: Discussionmentioning

confidence: 99%

“…Yet current literature has documented a decrease in autopsy frequency; the reasons are diversified, including technological advances in clinical testing and imaging and apprehension of potential medicolegal consequences resulting from discrepant findings. Nevertheless, disparity rates between clinical and post-mortem diagnoses concerning the cause of death are reported to reach up to 17.2% [18]. …”

Section: Discussionmentioning

confidence: 99%

Clinical diagnosis versus autopsy findings in polytrauma fatalities

Buschmann

Gahr

Tsokos

et al. 2010

Scand J Trauma Resusc Emerg Med

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ObjectivesThe aim of the study was to determine if differences in clinical diagnosis versus autopsy findings concerning the cause of death in polytrauma fatalities would be detected in 19 cases of fatal polytrauma from a Level 1 trauma centre.MethodsClinical diagnoses determining the cause of death in 19 cases of fatal polytrauma (2007 - 2008) from a Level 1 trauma centre were correlated with autopsy findings.ResultsIn 13 cases (68%), the clinical cause of death and the cause of death as determined by autopsy were congruent. Marginal differences occurred in three (16%) patients while obvious differences in interpreting the cause of death were found in another three (16%) cases. Five fatalities (three with obvious differences and two with marginal differences) were remarked as early death (1-4 h after trauma) and one fatality with marginal differences as late death (>1 week after trauma). Obvious and marginal discrepancies mostly occurred in the early phase of treatment, especially when severely injured patients were admitted to the emergency room undergoing continued cardiopulmonary resuscitation, i. e. limiting diagnostic procedures, and thus the clinical cause of death was essentially determined by basic emergency diagnostics.ConclusionsAutopsy as golden standard to define the cause of death in fatal polytrauma varies from the clinical point of view, depending on the patient's pre-existing condition, mechanism of polytrauma, necessity of traumatic cardiopulmonary resuscitation, survival time, and thus the possibility to perform emergency diagnostics. An autopsy should be performed at least in cases of early fatal polytrauma to help establishing the definite cause of death. Moreover, autopsy data should be included in trauma registries as a quality assessment tool.

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Discrepancies Between Clinical and Autopsy Diagnoses

Cited by 69 publications

References 21 publications

The Role of Necropsy in Diagnostic Dilemmas as Seen in a Tertiary Hospital in North Central Nigeria

The Role of Necropsy in Diagnostic Dilemmas as Seen in a Tertiary Hospital in North Central Nigeria

Diffuse Alveolar Damage of the Lungs in Forensic Autopsies: Assessment of Histopathological Stages and Causes of Death

Clinical diagnosis versus autopsy findings in polytrauma fatalities

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