The Value of Necropsy in Quality Control of Medical Diagnosis – The Gold Standard for Years to Come

Gutierrez, Paulo Sampaio; Brito, Thales de; Lopes, M. Beatriz S.; Alves, Venâncio Avancini Ferreira

doi:10.1590/s1807-59322009000300002

Cited by 9 publications

(5 citation statements)

References 10 publications

(9 reference statements)

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“…For animals younger than one year, three additional categories: neonatal (up to two weeks), juvenile (two weeks to six months) and juvenile-adult (six months to one year) were defined. For the statistical analysis these categories were coded as 0.02, Necropsy remains the gold standard for diagnosis 30 and in this study also, the comparison refers to the pathological diagnosis. Therefore, when analyzing the influence of a diagnosis attribute on the occurrence of diagnosis, the attributes of the pathological diagnosis were used in all cases where both or only the pathological diagnosis were/was available.…”

Section: Comparison Of Diagnosesmentioning

confidence: 99%

“…20,38,47 Despite advances in modern medicine, autopsy remains the gold standard for diagnosis. 30 Inadequate or delayed communication between clinicians and pathologists also sustains declining interest on the part of clinicians. Moreover, fear of a mistake being discovered through an autopsy and possible subsequent malpractice prosecution contribute to clinicians' reluctance, 1,28 even if no increased litigation has been related to high autopsy rates.…”

Section: Introductionmentioning

confidence: 99%

“…8,28,49,69,72 The desire among laypersons to leave the body intact and to bury the dead promptly also contribute to families' reluctance to consent to necropsies because of the delay caused by the procedure. 30,54 Furthermore, organ retention scandals have diminished public trust in pathology. 18 Last but not least, financial constraints and the suspension of minimum autopsy percentages both contribute to the decline in autopsy rates.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Correlation of Clinical and Pathological Diagnoses in Cats and Dogs

Schertenleib¹,

Pospischil²,

Hässig³

et al. 2016

Journal of Comparative Pathology

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Der Vergleich der klinischen und pathologischen Diagnose ist Voraussetzung für die Qualitätskontrolle, wird aber in der Veterinärmedizin nur selten gemacht. Für je 1000, an der Universität Zürich, untersuchte und sezierte Hunde und Katzen wurden das Vorkommen und die Übereinstimmung der für den Tod verantwortlichen Diagnose retrospektiv untersucht und mögliche Einflussfaktoren evaluiert. Bei 5.8% der Katzen und 5.2% der Hunde wurde keine Diagnose gestellt; bei 2.6% bzw. 3.6% der Fälle wurde nur eine klinische und bei 17.8% bzw. 11.2% nur eine pathologische Diagnose gefunden. Von den 73.9% Katzen und 79.8% Hunden mit beiden Diagnosen, stimmten diese in 38.3% und 36.2% total und in 17.9% bzw. 16.0% gar nicht überein. Die verbleibenden Fälle (43.8% und 47.8%) wurden durch die Sektion in verschiedenem Ausmaß spezifiziert. Bei beiden Spezies hatten die Art des Todes, die klinische Abteilung die das Tier zur Sektion sendete und die Qualität der Sektionsanamnese sowie bei Hunden zusätzlich die Zeitdauer zwischen Tod und Sektion, einen Einfluss auf das Vorkommen der Diagnosen. Hingegen beeinflussten das primär betroffene Organsystem und die der Diagnose zugrunde liegende Pathophysiologie bei beiden Spezies die Übereinstimmung am meisten. Deshalb liefert die Sektion in der Tiermedizin auch in Zeiten stark verbesserter klinischer Diagnostik und diagnostischer Methoden wertvolle Information für die Qualitätskontrolle und Ausbildung. The comparison of clinical antemortem and pathological postmortem diagnoses is a prerequisite for quality control but is rarely done in veterinary medicine. In 1000 cats and 1000 dogs examined and necropsied at the University of Zurich, the occurrence and concurrence of clinical and pathological diagnoses linked to death were evaluated and potential factors influencing them were correlated retrospectively. In 5.8% cats and 5.2% dogs no diagnosis was made; in 2.6% and 3.8% of cases only a clinical, and in 17.8% and 11.2%, respectively, only a pathological diagnosis was available. Of the 73.9% of cats and 79.8% of dogs with both diagnoses present, 38.3% and 36.2% were in total agreement, whereas total disagreement was found in 17.9% and 16.0%, respectively. The remaining cases (43.8% and 47.8%) exhibited different levels of further diagnosis specification through necropsy. In both species manner of death, the clinical discipline sending the animal to necropsy and the quality of the necropsy request, as well as the timespan between death and necropsy in dogs, proved to influence the occurrence of diagnoses. By contrast, the organ system affected and the disease entity of a certain diagnosis were for both species the most influential factors in the concurrence of diagnoses. Therefore in veterinary medicine, even in times of improving diagnostic abilities, necropsy still reveals important information for quality control and education. Other titles: Korrelation von klinischen mit pathologischen Diagnosen bei Katzen und Hunden

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Section: Comparison Of Diagnosesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Correlation of Clinical and Pathological Diagnoses in Cats and Dogs

Schertenleib¹,

Pospischil²,

Hässig³

et al. 2016

Journal of Comparative Pathology

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“…Despite the 30% discrepancy between clinical and pathological diagnoses in Europe and the decreasing number of performed autopsies, [ 8 – 13 ] cases of clinically unsuspected conditions, which are revealed after postmortem examination, have been published after various studies have been completed. [ 14 – 16 ] Since hemochromatosis is difficult to diagnose due to the rapid internal organ dysfunction development, autopsy remains one of the main rare condition identifying methods.…”

Section: Introductionmentioning

confidence: 99%

Autopsy relevance determining hemochromatosis

Chmieliauskas

Banionis²,

Laima³

et al. 2017

Medicine

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Rationale:Hemochromatosis is a disorder, associated with an abnormal accumulation of iron leading to toxic organ damage. Clinical symptoms develop during a long period of time, thus, determining accidental or late diagnosis, usually when complications are evident.Patient concerns:A 53-year-old man was brought to the emergency unit with symptoms of hypovolemic shock without any apparent cause, which ultimately led to multiple organ failure, severe metabolic acidosis.Diagnoses:The final diagnosis of hemochromatosis was determined after the autopsy.Interventions:Abnormal findings included a black-grayish pancreas, without any surrounding tissue reaction, and a dilated congestive cardiomyopathy. Histological findings revealed significant hemosiderin deposits in the internal organs, which were more distinct in the pancreas, liver, and kidneys.Outcomes:Patient death in less than 12 hours.Lessons:The necessity of a genetic examination after the autopsy, regarding this case was undeniable, especially focusing on the first-degree relatives, helping to diagnose and prescribe an adequate and early treatment.

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“…Se realiza la apertura de la piel mediante una incisión longitudinal en 'Y' o 'T' que compromete el tórax y el abdomen en toda su longitud (11)(12)(13) , luego de la cual se realiza la evisceración de los órganos mediante los métodos de Rokitansky (disección y evisceración in situ), Virchow (evisceración de cada órgano individualmente), Letulle (en bloque) o Ghon (por sistemas), y al final se efectúa el cierre de la piel (7,14,15) . Existen propuestas para la realización de necropsias mínimamente invasivas o de forma virtual guiada por imáge-nes (16) ; estas conllevan costos muy elevados y no superan la información científica que se obtiene del estudio anátomo patológico de los órganos.…”

Section: Introductionunclassified

Pequeña incisión suprapúbica facilita el consentimiento en necropsias perinatal y pediátrica

2016

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Pequeña incisión suprapúbica facilita el consentimiento en necropsias perinatal y pediátrica ResumenObjetivo. Presentar un tipo de incisión de la piel en la necropsia perinatal y pediátrica que permite la autorización de los padres que se hubieran negado con la técnica de incisión habitual. Métodos. Las necropsias se realizaron en 20 fetos, 15 neonatos y 8 infantes en el Hospital Madre Niño "San Bartolomé". Esta técnica consiste en una incisión de la piel transversal, suprapúbica, de 10 cm de longitud aproximadamente, evaluación manual de cavidades y órganos, evisceración de los órganos con técnica Letulle (en bloque) o tipo Virchow (por órganos), y cierre de la piel con sutura subdérmica. Resultados. Esta técnica de incisión de la piel facilitó el consentimiento de necropsia por los padres. Conclusiones. Con el procedimiento reportado se obtuvo la autorización por parte de los padres de las necropsias previamente negadas; se entregó a la madre el cadáver de su niño con una mínima incisión y se aseguró un buen estudio necrópsico. Palabras clave. Necropsia Fetal y Pediátrica; Calidad en Necropsias. Abstract Objective. To report a new approach for perinatal and pediatric necropsy that allows parental consent. Methods. Experience with necropsies in 20 stillborn, 15 neonates and 8 infants is presented with this new approach; the parents had refused the use of the standard body incision. Through a small transversal about 10 cm incision in the suprapubic region, manual evaluation of the abdominal and pelvic cavities was performed, and then the viscera were obtained by either the Letulle`s technique (a single block) or the Virchow´s technique (organ by organ). The incision is closed by subdermic suture. Conclusions. This technique is well accepted by the parents because the skin surface and the body as a whole appear little disturbed.

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The Value of Necropsy in Quality Control of Medical Diagnosis – The Gold Standard for Years to Come

Cited by 9 publications

References 10 publications

Correlation of Clinical and Pathological Diagnoses in Cats and Dogs

Correlation of Clinical and Pathological Diagnoses in Cats and Dogs

Autopsy relevance determining hemochromatosis

Pequeña incisión suprapúbica facilita el consentimiento en necropsias perinatal y pediátrica

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