Accuracy of Admission and Pre-autopsy Clinical Diagnoses in the Light of Autopsy Findings: a Study Conducted in Budapest

Abstract

<jats:p> Pre- and post-autopsy diagnoses of underlying cause of death were compared in consecutive autopsies on persons aged 30 to 80 years; 1000 from each of two pathology departments in Budapest. Data on admission diagnoses and on contributory causes of death were also analysed. At autopsy, the percentages of deaths by underlying cause were neoplasms (any site) 34.9%, diseases of the circulatory system 40.2%, digestive system 13.8%, endocrine, nutritional, metabolic or immune systems 2.7%, and respiratory system 2.2%. </jats:p><jats:p> For these five disease groupings, the percentages of cases diagnosed clinically as the underlying cause of death which were confirmed at autopsy were, respectively, 90.9%, 84.0%, 82.9%, 55.2% and 32.5%. Although, out of 697 cases with an autopsy diagnosis of neoplasia as the underlying cause, there were only 61 (8.8%) where neoplasms were not diagnosed clinically as the underlying cause, this conceals the fact that in 130 (18.7%) the two diagnoses differed as to the site of the primary neoplasm (ICD 3 digit code). </jats:p><jats:p> The fact that 43% of post-mortem diagnoses (ICD major category) of underlying cause are missed on admission, and that 19% are missed clinically, indicates that improved clinical diagnostic procedures have not diminished the need for high autopsy rates. Morbid anatomy needs to be better resourced. </jats:p>

Are coroners' necropsies necessary? A prospective study examining whether a "view and grant" system of death certification could be introduced into England and Wales

“…Ferdandez-Segoviano 1988 10 39 Karwinski 1989 12 40 Carvalho 1991 36 41 Stambouly 1993 28 42 Teo 1993 54 43 McKelvie 1993 12 44 Veress 1993 27 45 Veress 1994 15 46 Szende 1994 43 47 Manzini 1995 42 48 Goldstein 1996 12 49 Kendrey 1996 59 50 Zehr 1997 20 51 Blosser 1998 21 52 Burton 1998 44 53 Ermenc 1999 13.5 expected to show any signs externally. Therefore, viewing the body should make little diVerence to the ability to decide a cause of death.…”

Priorities for Research in the Field of Indoor Air Pollution

“…In these circumstances, falsely positive and false ly negative diagnoses of lung cancer as the underlying cause of death are commonly made by clinicians [10]. In a recent study in which pre-autopsy diagnoses made by cli nicians were compared with autopsy diagnoses, 30.6% of clinical diagnoses of lung cancer as the underlying cause of death were not confirmed at autopsy and 38.1 % of fatal lung cancers were not detected clinically [11], Thus, although ETS in high concentration is certainly irritant to the eyes and upper respiratory tract and although ETS, like other forms of smoke, aggravates the symptoms of asthma and other upper respiratory tract conditions, there is no reliable evidence that the risk of lung cancer is increased by realistic exposure to ETS. What is more, despite the widespread banning of smoking in workplaces, only 1 of 9 studies has provided evidence of a statistically significant excess of lung cancer as a con sequence of exposure to ETS in the workplace [29].…”

“…However, in the case of chronic diseases such as chronic bronchitis and emphyse ma, and in the case of neoplastic diseases such as lung cancer, the exposure data needed relate to periods of 20-30 or more years prior to the diagnosis of the disease and reliable exposure data extending over such long periods are rarely, if ever, available. Some statisticians and some epidemiologists appear not to be aware of the extent of the imprecision of the clinical diagnoses made in living pa tients or the inaccuracy of mortality data for internal can cers, including lung cancer in the absence of autopsy [10,11]. Imprecision of exposure data and diagnostic data combined with less than careful or rigorous interpretation of data has resulted in the popular media being flooded with scare stories and consequent diversion of research funds away from real problems to equivocal or non-exis tent problems.…”

Priorities for Research in the Field of Indoor Air Pollution

“…In these circumstances, falsely positive and falsely negative diagnoses of lung cancer as the underlying cause of death are commonly made by clinicians [ 10]. In a recent study in which pre-autopsy diagnoses made by clinicians were compared with autopsy diagnoses, 30.6% of clinical diagnoses of lung cancer as the underlying cause of death were not confirmed at autopsy and 38.1 % of fatal lung cancers were not detected clinically [ 11 ].…”

“…However, in the case of chronic diseases such as chronic bronchitis and emphysema, and in the case of neoplastic diseases such as lung cancer, the exposure data needed relate to periods of 20-30 or more years prior to the diagnosis of the disease and reliable exposure data extending over such long periods are rarely, if ever, available. Some statisticians and some epidemiologists appear not to be aware of the extent of the imprecision of the clinical diagnoses made in living patients or the inaccuracy of mortality data for internal cancers, including lung cancer in the absence of autopsy [10,11]. Imprecision of exposure data and diagnostic data combined with less than careful or rigorous interpretation of data has resulted in the popular media being flooded with scare stories and consequent diversion of research funds away from real problems to equivocal or non-existent problems.…”