Diagnostic Yield of the Autopsy in a University Hospital and a Community Hospital

Abstract

To determine the extent to which autopsies yield unexpected findings that are relevant to the patient's death and whether cases with a high yield of such findings can be identified selectively, we studied a total of 233 autopsies at a university hospital and at a community hospital. The rates at which autopsies detected major unexpected findings whose premortem diagnosis would probably have improved survival were 11 percent at the university hospital and 12 percent at the community hospital. Major unexpected findings whose premortem diagnosis would not have prolonged survival were found in another 12 and 21 percent of cases, respectively. Pulmonary embolism and fungal infections in immuno-compromised hosts were the most common major unexpected findings. Neither we nor the patients' physicians were able to identify from the clinical data the autopsies likely to have high yields. Furthermore, the physicians' estimates of an autopsy's expected yield were similar for patients evaluated by autopsy and for matched patients who were not. We conclude that the autopsy continues to yield clinically relevant findings at a high level and that it is not currently possible to predict which cases will have high yields. Autopsies are vital to ensure the quality of medical care, and autopsy rates must be increased substantially if this role is to be fully realized.

Correlação diagnóstica anatomoclínica. Aferição retrospectiva do diagnóstico clínico em necrópsias

“…2 -A necrópsia tem sido freqüentemente considerada como um dos métodos mais serepresentado pela média da estimativa da confirmação anatomopatológica do diagnóstico clí-nico: 70,97% (286-83/335 = ) significando que mesmo quando o diagnóstico clínico possa estar correto há um substancial número de outros diagnósticos de importância que serão revelados somente na necróp-sia 8,11,19,23,28,32,38,39 .…”

“…Tem-se demonstrado, no entanto, que mesmo quando essa certeza possa existir, a necrópsia leva a alterações significativas nos diagnósticos anteriormente formulados 8,10,23,28 .…”

Discrepancies between clinical diagnoses and autopsy findings

“…In 1983, these discrepancies were classified by Goldman et al (9) considering their importance for clinical practice. He suggested that attention be given to therapeutically significant errors whose correction could contribute to medical care improvement (4,8,10,11). These errors correspond to Goldman's classes I and II: significant diagnosis, for which the detection during lifetime would probably change the management and result in cure or prolonged survival, and significant diagnosis, for which detection during a lifetime would probably not change the management because there was no better therapy at that time (9).…”

Pulmonary thromboendarterectomy

“…Hastaların %10'unda Lupus antikoagülanı bulunmuş-tur (12). Hastaların %20'si antikardiolipin antikorları ve lupus antikoagülanı, ya da her ikisini taşır (13). KTEPH hastalarının %39'unda Faktör VIII plazma düzeyi yüksek bulunmuştur (14).…”