Discrepancies Between Clinical and Autopsy Diagnoses
Discrepancies Between Clinical and Autopsy Diagnoses
Although it is known that autopsies often disclose unexpected findings, few studies have been published that address the effect of institutional setting, selection bias, and length of hospitalization. Records of medical autopsies from 3 institutional settings were studied for discrepancies between clinical and autopsy findings. The settings were university hospital (n = 85); community hospital (n = 146); and private autopsy(n = 60), which were referred from various community hospitals and paid for by family members. The same prosector performed the autopsies in the community and private settings. The overall rate of major discrepancy that involved the cause of death was 17.2%. Factors that increased the likelihood of missed diagnoses were private setting (P = .0005), community setting (P = .02), and short hospital stay before death (P = .02). Additional major findings were present in 28.5% of autopsies. Length of hospital stay before death, institution, and selection bias all affect the rate of major unexpected findings in hospital-based autopsies.
Hospital-based medical autopsies are a well-established tool for education and quality assurance. However, several studies have documented a decrease in the autopsy rate and in the importance given to autopsy by clinicians. 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. Despite this declining interest in autopsies, however, clinicopathologic discrepancy rates remain high. A meta-analysis based on a College of American Pathologists survey of 248 institutions in the United States noted that nearly 40% of autopsies yield at least 1 unexpected finding that contributed to the patient's death.
Because the rate of autopsy is currently low, the true rate of inaccurate or missed diagnoses in patients who die in the hospital remains unknown in the United States. The effect of sampling on the rate of hospital-based autopsies has not been studied in detail. Factors that likely affect missed diagnoses include institutional setting; motivation for the autopsy, whether academic, physician curiosity, or family mistrust of the medical system; and duration of hospitalization. The purpose of the present study was to test the effect of these variables on the rate of major discrepancies between clinical and autopsy findings.
Abstract and Introduction
Abstract
Although it is known that autopsies often disclose unexpected findings, few studies have been published that address the effect of institutional setting, selection bias, and length of hospitalization. Records of medical autopsies from 3 institutional settings were studied for discrepancies between clinical and autopsy findings. The settings were university hospital (n = 85); community hospital (n = 146); and private autopsy(n = 60), which were referred from various community hospitals and paid for by family members. The same prosector performed the autopsies in the community and private settings. The overall rate of major discrepancy that involved the cause of death was 17.2%. Factors that increased the likelihood of missed diagnoses were private setting (P = .0005), community setting (P = .02), and short hospital stay before death (P = .02). Additional major findings were present in 28.5% of autopsies. Length of hospital stay before death, institution, and selection bias all affect the rate of major unexpected findings in hospital-based autopsies.
Introduction
Hospital-based medical autopsies are a well-established tool for education and quality assurance. However, several studies have documented a decrease in the autopsy rate and in the importance given to autopsy by clinicians. 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. Despite this declining interest in autopsies, however, clinicopathologic discrepancy rates remain high. A meta-analysis based on a College of American Pathologists survey of 248 institutions in the United States noted that nearly 40% of autopsies yield at least 1 unexpected finding that contributed to the patient's death.
Because the rate of autopsy is currently low, the true rate of inaccurate or missed diagnoses in patients who die in the hospital remains unknown in the United States. The effect of sampling on the rate of hospital-based autopsies has not been studied in detail. Factors that likely affect missed diagnoses include institutional setting; motivation for the autopsy, whether academic, physician curiosity, or family mistrust of the medical system; and duration of hospitalization. The purpose of the present study was to test the effect of these variables on the rate of major discrepancies between clinical and autopsy findings.
