Discrepancies between clinical and postmortem diagnoses in Jamaica: a study from the University Hospital of the West Indies

Abstract

Aims: It has previously been shown that the low necropsy request rate at the University Hospital of the West Indies (UHWI) in Jamaica (35.3%) results primarily from clinicians' confidence in clinical diagnoses and laboratory investigations. This study aimed to determine the rates of discrepancy between clinical and necropsy diagnoses at the UHWI, because many previous studies from other institutions have shown persistent high rates of discrepancy, despite advances in medical investigative technology over the past several years. Methods: Data were extracted retrospectively from consecutive necropsies performed at the UHWI over a two year period. The data were analysed to determine the categories and rates of discrepancy, and to determine the relation between discrepancy rates and age, sex, type and number of diagnoses for each patient, hospital service, and length of hospitalisation. Results: Necropsies were performed on 446 patients; 348 were suitable for further analysis. The overall discrepancy rate was 48.4% and the diagnoses with the highest individual discrepancy rates were pneumonia (73.5%), pulmonary thromboembolism (68.3%), and myocardial infarction (66.7%). Males and older patients were more likely to have discrepant diagnoses. There was a high frequency of discrepancies in patients who died within 24 hours of admission, but there was no consistent relation between length of hospitalisation and discrepancy rate. Conclusions: The high discrepancy rates documented at the UHWI are similar to those reported globally. This study supports previous attestations that the necropsy remains a vital tool for determining diagnostic accuracy, despite modern modalities of clinical investigation and diagnosis.

Discrepâncias clínico-patológicas e achados cardiovasculares em 409 autópsias consecutivas

“…We not observed a significant correlation between the last admission unit and the level of agreement, in contrast to Gibson et al 18 that found the lowest frequent of concordant diagnoses in the emergency room (33.6%) and the highest (68.4%) in the intensive care unit. The elevated discrepancy rates with advancing patient age evidenced by this author 18 was not observed in our results and in analysis described previously 3,12 . In cases with a poor prognosis, which are more common in elderly, it is possible that the physician and the patient's relatives decide not to proceed with clinical investigations, which can contribute to a greater chance of misdiagnosis in the older population 9 .…”

“…There was agreement between the clinical and pathological diagnoses in 33.8% of these cases. Respiratory diseases, in particular pneumonia, were the main causes of death diagnosed in discordant acute myocardial infarction cases, probably due to the similarities in both the clinical symptoms of patients and occasionally radiological signs between the two diseases 6,18 . Most of these patients were hospitalized because of pulmonary infections and evolved with an acute aggravation of the symptoms which was attributed to the pulmonary infection and not acute coronary syndrome.…”

Discrepancies Between Clinical and Autopsy Diagnoses

“…However, it seems that the impact of medical imaging in reliably recognizing certain clinical entities remains unproven. 2,3,19 Moreover, overreliance on these advanced techniques, especially radiologic imaging, has been shown to occasionally contribute directly to inaccurate or unrecognized diagnoses. 12 discrepant diagnoses were the result of a misleading diagnostic test result.…”

“…[1][2][3][4][5] However, several studies have documented a decrease in the autopsy rate and in the importance given to autopsy by clinicians. 6,7 The causes for the decreasing autopsy rate are diverse and include technological advances in clinical testing and imaging, fear of potential medicolegal problems that could result from discrepant findings, and a declining interest in autopsies among pathologists.…”

Autopsy in older medical patients: concordance in ante- and post-mortem findings and changing trends

“…Concordance between ante-mortem and post-mortem diagnoses was seen in 64 patients (74%), which is consistent with other studies reported in the literature. [2][3][4][5][6][7] Unsuspected medical conditions relevant to death that were suggested by post-mortem examination and were not recorded as known during life are shown in Table 2.…”