TY - JOUR
T1 - Comparison of clinical diagnoses and autopsy findings
T2 - Six-year retrospective study
AU - Marshall, Hyejong Song
AU - Milikowski, Clara
PY - 2017/9
Y1 - 2017/9
N2 - Context.-The frequency of autopsies has declined inmost developed countries beginning in the latter half of the 20th century. During this time period the technology of medicine made significant advances; however, it is important to regularly reevaluate the role of the autopsy to confirm suspected diagnoses and identify unsuspected findings. Objective.-To determine what portion of autopsies reveal clinically meaningful unexpected findings. Design.-Reports that included clinical histories of autopsies performed at Jackson Memorial Hospital during the 6 years between 2009 and 2014 were reviewed by 2 pathologists. Each case was classified using the Goldman Classification. Results.-In the given time period, 923 autopsies were performed; 512 patients (55.5%) were adults. A total of 334 cases were subject to review after excluding those with a short (, 1 day) hospital stay, restriction to a single organ or body cavity, and cases referred from other facilities. A total of 33 of 334 cases (9.9%) were identified as class I discrepancy, where the autopsy revealed a discrepant diagnosis with a potential impact on survival or treatment. Critical findings, such as untreated infection (15 of 33 cases; 45.5%), pulmonary embolism (8 of 33 cases; 24.2%), and undiagnosed malignancy (6 of 33 cases; 18.2%), were found in these cases. Major significant findings that had not been clinically detected, whether clinically manageable or not (class I and II), were found in 65 of 334 cases (19.5%). Conclusion.-Despite intensive modern clinical investigations, autopsies continue to reveal major antemortem diagnostic errors in a significant number of cases.
AB - Context.-The frequency of autopsies has declined inmost developed countries beginning in the latter half of the 20th century. During this time period the technology of medicine made significant advances; however, it is important to regularly reevaluate the role of the autopsy to confirm suspected diagnoses and identify unsuspected findings. Objective.-To determine what portion of autopsies reveal clinically meaningful unexpected findings. Design.-Reports that included clinical histories of autopsies performed at Jackson Memorial Hospital during the 6 years between 2009 and 2014 were reviewed by 2 pathologists. Each case was classified using the Goldman Classification. Results.-In the given time period, 923 autopsies were performed; 512 patients (55.5%) were adults. A total of 334 cases were subject to review after excluding those with a short (, 1 day) hospital stay, restriction to a single organ or body cavity, and cases referred from other facilities. A total of 33 of 334 cases (9.9%) were identified as class I discrepancy, where the autopsy revealed a discrepant diagnosis with a potential impact on survival or treatment. Critical findings, such as untreated infection (15 of 33 cases; 45.5%), pulmonary embolism (8 of 33 cases; 24.2%), and undiagnosed malignancy (6 of 33 cases; 18.2%), were found in these cases. Major significant findings that had not been clinically detected, whether clinically manageable or not (class I and II), were found in 65 of 334 cases (19.5%). Conclusion.-Despite intensive modern clinical investigations, autopsies continue to reveal major antemortem diagnostic errors in a significant number of cases.
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U2 - 10.5858/arpa.2016-0488-OA
DO - 10.5858/arpa.2016-0488-OA
M3 - Article
C2 - 28657772
AN - SCOPUS:85028699084
VL - 141
SP - 1262
EP - 1266
JO - Archives of Pathology and Laboratory Medicine
JF - Archives of Pathology and Laboratory Medicine
SN - 0003-9985
IS - 9
ER -