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The value of autopsies in the era of high-tech medicine: discrepant findings persist.

Authors
  • Kuijpers, Chantal C H J1
  • Fronczek, Judith2
  • van de Goot, Frank R W1
  • Niessen, Hans W M3
  • van Diest, Paul J4
  • Jiwa, Mehdi1
  • 1 Symbiant Pathology Expert Centre, Alkmaar, The Netherlands. , (Netherlands)
  • 2 Symbiant Pathology Expert Centre, Alkmaar, The Netherlands Department of Pathology, VU Medical Centre, Amsterdam, The Netherlands. , (Netherlands)
  • 3 Department of Pathology, VU Medical Centre, Amsterdam, The Netherlands Department of Cardiac Surgery, VU Medical Centre, Amsterdam, The Netherlands ICaR-VU, VU Medical Centre, Amsterdam, the Netherlands. , (Netherlands)
  • 4 Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands. , (Netherlands)
Type
Published Article
Journal
Journal of Clinical Pathology
Publisher
BMJ
Publication Date
Jun 01, 2014
Volume
67
Issue
6
Pages
512–519
Identifiers
DOI: 10.1136/jclinpath-2013-202122
PMID: 24596140
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Although the autopsy is still the gold standard for quality assessment of clinical diagnoses, autopsy rates have been declining over the last decades to <10%. The aim of this study was to investigate the value of autopsies in the high-tech medicine era by determining the frequency of discrepancies between clinical and autopsy diagnoses. We classified all adult autopsy cases (n=460), performed at Symbiant, Pathology Expert Centre, in 2007 and 2012/2013, as having major, or minor discrepancy or total concordance. The roles of possible contributory factors were analysed. Finally, we assessed the role of microscopic examination in identifying cause of death. Major and minor discrepancies were found in 23.5% and 32.6% of the classifiable autopsies, respectively. Most commonly observed major discrepancies were myocardial infarction, pulmonary embolism and pneumonia. Improper imaging and discontinuation of active treatment were significantly associated with a higher and a lower frequency of major discrepancies, respectively. Comparing 2007 and 2012/2013, the frequency of minor discrepancies significantly increased from 26.8% to 39.3%. Final admission length of >2 days was significantly associated with a lower frequency of class III minor discrepancies. Microscopic examination contributed to establishing cause of death in 19.6% of the cases. Discrepant findings persist at autopsy, even in the era of high-tech medicine. Therefore, autopsies still should serve as a very important part of quality control in clinical diagnosis and treatment. Learning from individual and system-related diagnostic errors can aid in improving patient safety. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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