Autopsy findings and clinical diagnoses: A review of 1,000 cases

Sarode, Venetia; Datta, B N; Banerjee, Arundhati; Banerjee, C. K.; Joshi, Kusum; Bhusnurmath, Bharti; Radotra, BD

doi:10.1016/0046-8177(93)90300-6

Cited by 109 publications

(60 citation statements)

References 16 publications

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“…In 50% of cases, the diagnoses were made at autopsy, and many times they included important diseases such as bronchopneumonias (46%), neoplasias (37.9%), venous thromboses (82.5%) and pulmonary embolisms (80.3%). These data agree with the literature, which shows that 45% of the bronchopneumonias are diagnosed at autopsy (6), as well as 26 to 44% of the neoplasias (6,21,23,24) and 87% of the pulmonary embolisms (15,25).…”

Section: Discussionsupporting

confidence: 82%

“…Several reports have considered the importance of autopsy for clinical practice (7,8,16,20,21). The autopsy discoveries are essential elements to provide reliable data on epidemiology, and they can provide the answers to important questions in clinical practice: the identification of the main pathology responsible for signs and symptoms, the confirmation of clinical diagnoses, the establishment of the cause of death, the determination of the accuracy of diagnostic tests, providing data about the clinical course of some diseases, and others (3,8,19,20).…”

Section: Discussionmentioning

confidence: 99%

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Discrepancies between clinical diagnoses and autopsy findings

Coradazzi

Morganti

Montenegro

2003

Braz J Med Biol Res

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Autopsy examination is considered to be an essential element for medical auditing and teaching. Despite the significant progress in diagnostic procedures, autopsy has not always confirmed the clinical diagnosis. In the present study, we compared the diagnosis recorded on medical charts with reports of 96 autopsies performed at the University Teaching Hospital of the Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil, between 1975 and 1982, and of 156 autopsies performed at the same institution between 1992 and 1996. The clinical diagnosis of the basic cause of death was confirmed at autopsy in 77% of cases. The percent confirmation fell to 60% when the immediate terminal cause of death was considered, and in 25% of cases, the terminal cause was only diagnosed at autopsy. The discrepancies between clinical and autopsy diagnosis were even larger for secondary diagnoses: 50% of them were not suspected upon clinical diagnosis. Among them, we emphasize the diagnosis of venous thromboses (83%), pulmonary embolisms (80%), bronchopneumonias (46%) and neoplasias (38%). Iatrogenic injuries were very frequent, and approximately 90% of them were not described in clinical reports. Our results suggest that highly sensitive and specific diagnostic tests are necessary but cannot substitute the clinical practice for the elaboration of correct diagnoses.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Discrepancies between clinical diagnoses and autopsy findings

Coradazzi

Morganti

Montenegro

2003

Braz J Med Biol Res

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“…A recent South African study found 21% of adults dying in hospital with a pre-mortem diagnosis of TB had no TB at autopsy (Martinson et al, 2007), while a study conducted in Italy, 36% of deceased AIDS patients with clinical diagnoses of TB had no evidence of TB at autopsy (Monforte et al, 1996). On the other hand, and of more concern to public health, are studies similar to ours conducted in the USA that suggest 5% of notified TB cases are diagnosed only after death (Rieder et al, 1991;DeRiemer et al, 1999), plus several large autopsy studies showing that TB is missed in life in 18-54% of cases with pathological evidence of active TB (Sarode et al, 1993;Rowińska-Zakrzewska et al, 1995;Murray et al, 2007). Our findings show that many of the assessed patients presented with symptoms that could have prompted clinicians to consider a thorough screening for TB.…”

Section: Discussionmentioning

confidence: 57%

High prevalence of tuberculosis diagnosed during autopsy examination at Muhimbili National Hospital in Dar es Salaam, Tanzania

Kilale¹,

Kimaro²,

Kahwa³

et al. 2013

Tanzania J Hlth Res

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Abstract:The primary aims of tuberculosis (TB) control programmes is early diagnosis and prompt treatment of infectious cases to limit transmission. Failure to diagnose and adequately treat TB could lead to premature death and unrecognized transmission of Mycobacterium tuberculosis. The proportion of missed TB cases has not been reported in Tanzania. The objective of this study was to quantify the number of cases of TB identified by autopsy. Deceased morbid bodies from Muhimbili National Hospital were involved. Retrieval of admission, diagnostic and other important records used to manage the patient after admission was done. Demographic information, site and type of disease, past medical history, chest x-ray report, clinical diagnosis and cause of death reported upon death certification were recorded. Lung tissues, lymphnodes and blood clots for HIV testing were collected. Biopsy tissues were processed through Ziehl Nielsen staining and examined by microscopy. The study involved 74 deceased individuals where 56 (75.7%) were males. Information for duration of seeking health care before death was available for 41(55.4%) subjects. Thirty-four (45.9%) cases received diagnosis before death. The main diagnoses were pneumonia 10(13.5%), heart failure 6(8.1%), AIDS-related illnesses 6 (6.8%) and malaria 5 (6.8%). The main clinical findings were wasting (51/74 (68.9%)) and abnormal fluid collection in different body cavities, 61(50.8%). In 24 out of 71(33.8%) biopsies acid fast bacilli (AFB) were detected. Records of lymphnodes examination were available in 63 cases and 22 of them had AFB. Twenty-two (34.9%) from the paratracheal and hilar lymphnodes were observed to have AFB. HIV was detected by ELISA in 19 (33.3%) out of 57 deceased, and 12 (63.2%) of the HIV positive deceased were co-infected with TB. Out of the 22 cases positive for AFB on tissue-biopsies 12 (54.5%) were HIV positive. There is a high number of TB cases diagnosed after death that could not be detected before they died. There is a need for increased awareness and to include postmortem data in the annual statistics of TB for precise reporting of the magnitude of the TB burden in the country. _____________________________________________________________________________________________

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“…He found infectious disease as the most common cause of death (46.8%), 66.7% of them were correctly diagnosed, with tuberculosis was making up 33.8% of the infections, while 82% of patients were accurately diagnosed. In other words, it is reported that 18% of the patients died from misdiagnosis [18]. Despite the fact that an autopsy is not applicable for all patients, it is evident that suspicion of potential tuberculosis should be kept in mind for similar patients.…”

Section: Discussionmentioning

confidence: 99%

Congenital heart disease and pulmonary tuberculosis

et al. 2010

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AbstractA 13-year-old boy with atrial septal defect and tricuspid valve abnormality was reported. He had crepitan ralles and signs of heart failure. He was treated with digital, diuretic and antimicrobial therapies. After clinical improvement he underwent surgery. The atrial septal defect was closed, and ringplasty was applied to the tricuspid valve. After the operation, he could not be extubated because of respiratory failure. On the seventh day following the surgery, he developed pneumothorax and hyportension and died. Postmortem examination showed bilateral diffuse pulmonary tuberculosis. The aim of this report is to emphasise the association of tuberculosis and congenital heart disease.

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Autopsy findings and clinical diagnoses: A review of 1,000 cases

Cited by 109 publications

References 16 publications

Discrepancies between clinical diagnoses and autopsy findings

Discrepancies between clinical diagnoses and autopsy findings

High prevalence of tuberculosis diagnosed during autopsy examination at Muhimbili National Hospital in Dar es Salaam, Tanzania

Congenital heart disease and pulmonary tuberculosis

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